title: Parents' perspectives on the deaths of their children in two Brazilian paediatric intensive care units.
abstract: OBJECTIVE
  To evaluate the quality of care offered to terminally ill children and their families in the last days of life in two Brazilian Paediatric Intensive Care Units (PICUs) from the parents' perspectives.
  
  
  METHODS
  This was a qualitative, exploratory study. Parents of a child who had died in one of the PICUs 6-12 months previously were invited to take part in two interviews: a private meeting with the PICU assistant physician who cared for their child, to discuss and review any outstanding issues related to the diagnosis, treatment, and prognosis, and a recorded interview with a researcher who was not involved in the child's treatment. Data from the interviews with the researcher were posteriorly grouped in categories according to recurrent terms.
  
  
  RESULTS
  Six categories emerged, three of which are reported here. The quality of communication was low; the medical staff frequently used technical terms, limiting understanding. Parental participation in the decision-making process was scarce; decisions were based on the medical perspective. Finally, families reported uncompassionate attitudes from the medical staff and excessive technology in the final moments surrounding the child's death, although nurses were highly involved with palliative care measures and demonstrated sympathetic and supportive postures.
  
  
  CONCLUSIONS
  The interviews uncovered deficiencies in the care provided to parents in the PICUs, indicating a need for changes in practice.
authors.affiliation: Registered Nurse and Master of Science student, Postgraduate Program in Child Health, PUCRS University, Brazil.
authors.forename: Gilda M C
authors.initials: GM
authors.lastname: Abib  El Halal
authors.forename: Jefferson P
authors.initials: JP
authors.lastname: Piva
authors.forename: Patrícia M
authors.initials: PM
authors.lastname: Lago
authors.forename: Michel G S
authors.initials: MG
authors.lastname: El Halal
authors.forename: Felipe C
authors.initials: FC
authors.lastname: Cabral
authors.forename: Cristine
authors.initials: C
authors.lastname: Nilson
authors.forename: Pedro C R
authors.initials: PC
authors.lastname: Garcia
mesh_terms: D000328:Adult; D001291:Attitude of Health Personnel; D001293:Attitude to Death; D001938:Brazil; D002648:Child; D002675:Child, Preschool; D003142:Communication; D003657:Decision Making; D005260:Female; D006801:Humans; D007223:Infant; D015278:Intensive Care Units, Pediatric / Q000458:organization & administration*; D008297:Male; D010290:Parents / Q000523:psychology*; D011368:Professional-Family Relations; D011787:Quality of Health Care / Q000458:organization & administration*; D013727:Terminal Care / Q000458:organization & administration*