Maintaining family life balance while facing a child's imminent death-A mixed methods study.
OBJECTIVE
To understand parents' experiences and needs during a child's end-of-life care at home and to identify systemic factors that influence its provision.


BACKGROUND
A child's end-of-life phase is an extremely difficult time for the whole family. Parents have specific needs, especially when they care for a dying child at home.


METHODS
Concurrent embedded mixed methods design.


METHODS
This sub-study of the nationwide survey, 'Paediatric End-of-Life Care Needs in Switzerland' (2012-2015) included 47 children who received EOL care at home from 2011-2012. We extracted quantitative data from patients' medical charts and obtained information via parental questionnaire and then compared parents whose child died at home or in hospital by computing generalized estimation equations. We thematically analysed interviews with parents who provided EOL care at home.


RESULTS
Parents created an intimate lifeworld and a sense of normality for the child at home. They constantly balanced the family's lifeworld with the requirements and challenges posed by the outside world. This work exhausted parents. Parental 'readiness' and social support drove EOL care for children at home. Parents needed practical help with housekeeping and had negative experiences when dealing with insurance. In only 34.8% of cases was a child's EOL home care supported by paediatric palliative care team.


CONCLUSIONS
Paediatric end-of-life care at home is only feasible if parents make extraordinary efforts. If family-centred end-of-life home care is provided by a hospital-based paediatric palliative home care team, which includes paid housekeeping help and psychological support, parents' needs could be better met.
Institute of Nursing Science, University of Basel, Switzerland.|Clinical Nurse Specialist, Triemli Hospital, Zurich, Switzerland.
Katri
http://orcid.org/0000-0003-1636-0513
K
Eskola
University Children's Hospital Zurich, Switzerland.
Eva
E
Bergstraesser
Institute of Nursing Science, University of Basel, Switzerland.|University Children's Hospital Zurich, Switzerland.
Karin
K
Zimmermann
Institute of Nursing Science, University of Basel, Switzerland.|Health Division, University of Applied Sciences Bern, Switzerland.
Eva
E
Cignacco
D002648:Child; D005190:Family; D005260:Female; D006801:Humans; D008297:Male; D010290:Parents / Q000523:psychology*; D011795:Surveys and Questionnaires; D013727:Terminal Care
end-of-life care; experiences; home care services; mixed methods; needs; nurses; nursing; paediatrics; parents; terminal care