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Updated: Aug 24, 2026
Setup and Execution of the Rapid Cycle Deliberate Practice Death Notification Curriculum
Published on: August 5, 2020
Provider perceptions of child deaths
Elena M Andresen1, Grace A Seecharan, Suzanne S Toce
1Department of Community Health, Salus Center, School of Public Health, Saint Louis University, MO 63104, USA. andresen@slu.edu
Insights
Physicians and nurses generally agreed on events surrounding pediatric end-of-life care. However, physicians reported more positive views of the quality of death, though overall care quality was high for most children.
Area of Science:
- Pediatric Palliative Care
- Healthcare Provider Perceptions
- End-of-Life Studies
Background:
- End-of-life care quality in children is understudied compared to adults.
- Key components of quality pediatric end-of-life care remain unclear.
- Provider perceptions of end-of-life care quality are not well understood.
Purpose of the Study:
- To compare nurse and physician perceptions of end-of-life care quality for pediatric patients.
- To assess agreement on events surrounding the death of children between physicians and nurses.
Main Methods:
- Utilized self-administered surveys following child deaths in an academic, tertiary care, faith-based children's hospital.
- Included 71 matched sets of physicians and nurses who cared for the same child.
- Employed closed-ended questions on quality of care derived from focus groups.
Main Results:
- High agreement (>75%) between physicians and nurses on events surrounding pediatric care, with exceptions for self-reported behaviors or expectations.
- Physicians generally held more positive perceptions of the quality of death compared to nurses.
- Despite role-based differences, positive reports on the quality of death were common among all providers.
Conclusions:
- Providers reported good quality of end-of-life care for most pediatric patients, with minimal reported pain and suffering.
- Role differences (physician vs. nurse) contributed to variations in perception.
- Further research is recommended to explore differences based on provider experience and in diverse care settings.
Background:
The quality and context of end-of-life care for children are not as well studied as they are for adults. The components of quality care are less clear, and differences between providers' perception of the quality of death are also not well understood.
Objective:
To compare nurse and physician perceptions of the quality of care and events of death of the same children.
Design:
Self-administered surveys following child deaths.
Setting:
Academic, tertiary care, faith-based children's hospital.
Participants:
Seventy-one matched sets of physicians and nurses who had cared for the same child at the time of death.
Main Outcome Measures:
Self-administered survey comprising closed-ended questions on the quality of care based on focus groups.
Results:
Physicians and nurses usually agreed on what had happened for events surrounding the child's care. In general, physicians tended to have more positive views of the death; however, positive reports of the quality of death of these patients were common for all providers. Agreement was high (>75%) for the matched sets with a few exceptions, including questions that asked for a provider's own behavior or expectation (eg, expecting further contact with a patient's family). However, chance-corrected agreement (measured as kappa) was low.
Conclusions:
There was a good quality of care at the time of death for most patients, with minimal pain and suffering reported by providers. There were differences in perception explained by roles (physicians vs nurses). Future research should examine differences by provider experience and in other care settings.
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