Talking with Families when Their Children Are Dying

Talking with a family whose child is dying is painful and challenging, yet can be a profoundly rewarding aspect of a physician’s work. At some time, every physician must give patients bad news. If this conversation is carried out well, with preparation, compassion, genuine empathy and skill, this adds considerably to the physician’s capacity to provide comprehensive care. Until recently however, there has been little or no training for this sensitive and delicate undertaking. Recent research indicates that breaking bad news to a family is a trainable skill. Data show a high consistency in the desirable traits for good communication. These are compassion, clinical accuracy, honesty, and availability. The literature emphasizes allowing sufficient time in a quiet private setting, following the families’ agenda, using nontechnical language, being emotionally responsive and not doing it alone. Training should include constructive feedback on communication skills, on patient’s perception, addressing interventions, and determining patient’s and caregivers’ support systems. Parental feedback during end-of-life care indicates that maintaining hope, while being honest about what is happening, enables families to cope. Integrating siblings of the dying child is an essential part of successfully talking with the family, as they too carry a heavy burden of grief.