• Na Ouyang, Justin N Baker, Prasanna J Ananth, M Tish Knobf, Jennifer M Snaman, and Shelli L Feder.
• Pain Research, Informatics, Multi-Morbidities, and Education (PRIME) Center, School of Nursing, Yale University (N.O., M.T.K., S.L.F.), Orange, Connecticut, USA. Electronic address: na.ouyang@yale.edu.
• J Pain Symptom Manage. 2024 Nov 1; 68 (5): 516524.e1516-524.e1.

ContextParent-clinician communication is essential for high-quality end-of-life (EOL) care in children with cancer. However, it is unknown how parent-clinician communication affects parents' experience in the first two years after their child's death.ObjectivesTo examine the association between communication and prolonged grief among parents whose child died from cancer and to explore the mediation effect of preparation for EOL care.MethodsWe analyzed data from a cross-sectional survey of parents of children who died from cancer in the prior 6-24 months. We used multiple linear regression to examine the association between communication variables and prolonged grief symptoms. We also examined how preparation for EOL mediates these associations.ResultsAcross N = 124 parents, the mean age was 46 years, 82% were White, and 64% were mothers. The average PG-13 sum score was 32.7 ± 10.6 (range 11-55, with higher scores indicating greater symptom severity). Most parents reported "very good/excellent" communication with clinicians (80%), adequate prognostic information (64%), and high levels of trust (90%). Nearly 39% of parents reported feeling "not at all prepared" for their child's EOL. Compared to parents who wanted more prognostic information, parents who perceived prognostic information to be adequate had significantly lower PG-13 sum scores (36.4 ± 10.8 vs. 30.5 ± 10.1, F = 9.26, P = 0.003). Preparation for EOL fully mediated this association.ConclusionEarly bereaved parents report severe prolonged grief symptoms. Interventions focused on providing adequate prognostic information and improving preparation for EOL may mitigate parental prolonged grief symptoms in the first two years of their bereavement.Copyright © 2024 American Academy of Hospice and Palliative Medicine. Published by Elsevier Inc. All rights reserved.

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