title: Suffering in children: opinions from parents and health-care professionals.
abstract: Alleviation of suffering is considered to be one of the important goals of medical interventions. Understanding of what constitutes suffering in children admitted to a pediatric intensive care unit (PICU) is lacking. This study aims to assess perceptions by parents, doctors, and nurses of suffering in critically ill children. We interviewed 124 participants (parents, physicians, and PICU nurses) caring for 29 admitted children in a 20-bed level-III PICU and performed a qualitative analysis. We found that most participants made a distinction between physical and existential suffering. Parents considered the child's suffering caused by or associated with visible signs as discomfort. Nurses linked suffering to the child's state of comfort. Physicians linked them to the intensity and impact of treatment and future perspectives of the child. Various aspects of the child's suffering and admission to a PICU caused suffering in parents.
  
  
  CONCLUSIONS
  Parents', physicians', and nurses' perceptions of suffering overlap but also show important differences. Differences found seem to be rooted in the relation to and kind of responsibility (parental/professional) for the child. The child's illness, suffering, and hospital admission cause suffering in parents. Health-care professionals in PICUs need to be aware of these phenomena.
authors.affiliation: Department of Pediatrics, Division of Intensive Care, Beatrix Children's Hospital, University Medical Center Groningen, PO Box 30.001, 9700 RB, Groningen, The Netherlands, w.de.weerd@umcg.nl.
authors.forename: Willemien
authors.initials: W
authors.lastname: de Weerd
authors.forename: Donald
authors.initials: D
authors.lastname: van Tol
authors.forename: Marcel
authors.initials: M
authors.lastname: Albers
authors.forename: Pieter
authors.initials: P
authors.lastname: Sauer
authors.forename: Marian
authors.initials: M
authors.lastname: Verkerk
mesh_terms: D000328:Adult; D002648:Child; D016638:Critical Illness / Q000523:psychology*; D003657:Decision Making; D005260:Female; D006282:Health Personnel / Q000523:psychology*; D006801:Humans; D015278:Intensive Care Units, Pediatric; D008297:Male; D010146:Pain / Q000523:psychology; D010290:Parents / Q000523:psychology*; D010465:Perception; D013315:Stress, Psychological / Q000175:diagnosis* / Q000523:psychology