Factors influencing parental readiness to let their child with cancer die.
BACKGROUND
One in four cases of childhood cancer is incurable. In these cases death can usually be anticipated and therefore preceded by a phase of palliative care. For parents, preparing to let their child die is an extraordinarily painful process. Most struggle to preserve their child. This study identified, from a parental perspective, the main factors that influence the transition from preserving life to letting go.


METHODS
A multi-centre, qualitative research, study was undertaken during the end-of-life (EoL) phase, comprising single or repeated interviews with 44 parents of 23 children with incurable cancer.


RESULTS
We discovered that uncertainty, fragmentation and anxiety underpin the preserving life perspective. A perspective of letting go could be supported by a variety of factors. These included: Certainty that the child cannot be cured, postponed grief, the perception of suffering, the ability to disentangle needs and the ability to parent meaningfully. Hope, creating a peaceful parent-child relationship, and the attitude of professionals, could support movements in either direction. Of these, certainty, and in most cases postponed grief, were pre-conditions for the transition towards letting go. Strategies such as not challenging the parents' suppression of grief, creating certainty about the child's condition and supporting parents in efforts to redefine their parental role, supported progress towards accepting a letting go perspective.


CONCLUSIONS
Parents' internal struggle between a preserving frame of mind and one of letting go is influenced by a combination of factors. However, professionals can influence some of these factors in order to facilitate this transition.
Kars
Marijke C
MC
Department of Nursing Science, University Medical Center Utrecht, Utrecht, The Netherlands. m.c.kars@umcutrecht.nl
Grypdonck
Mieke H F
MH
Beishuizen
Auke
A
Meijer-van den Bergh
Esther M M
EM
van Delden
Johannes J M
JJ
D000293:Adolescent; D000328:Adult; D001293:Attitude to Death; D002648:Child; D002675:Child, Preschool; D005260:Female; D006117:Grief; D006801:Humans; D007223:Infant; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000523:psychology*; D010287:Parent-Child Relations; D010290:Parents / Q000523:psychology*; D011368:Professional-Family Relations