• Kelly Nicole Michelson, Rachna Patel, Natalie Haber-Barker, Linda Emanuel, and Joel Frader.
• Division of Critical Care Medicine, Children's Memorial Hospital, Northwestern University, Chicago, IL, USA. kmichelson@childrensmemorial.org
• Pediatr Crit Care Me. 2013 Jan 1; 14 (1): e34-44.

ObjectiveDescribe the roles and respective responsibilities of PICU healthcare professionals in end-of-life care decisions faced by PICU parents.DesignRetrospective qualitative study.SettingUniversity-based tertiary care children's hospital.ParticipantsEighteen parents of children who died in the pediatric ICU and 48 PICU healthcare professionals (physicians, nurses, social workers, child-life specialists, chaplains, and case managers).InterventionsIn depth, semi-structured focus groups and one-on-one interviews designed to explore experiences in end-of-life care decision making.Measurements And Main ResultsWe identified end-of-life care decisions that parents face based on descriptions by parents and healthcare professionals. Participants described medical and nonmedical decisions addressed toward the end of a child's life. From the descriptions, we identified seven roles healthcare professionals play in end-of-life care decisions. The family supporter addresses emotional, spiritual, environmental, relational, and informational family needs in a nondirective way. The family advocate helps families articulate their views and needs to healthcare professionals. The information giver provides parents with medical information, identifies decisions or describes available options, and clarifies parents' understanding. The general care coordinator helps facilitate interactions among healthcare professionals in the PICU, among healthcare professionals from different subspecialty teams, and between healthcare professionals and parents. The decision maker makes or directly influences the defined plan of action. The end-of-life care coordinator organizes and executes functions occurring directly before, during, and after dying/death. The point person develops a unique trusting relationship with parents.ConclusionsOur results describe a framework for healthcare professionals' roles in parental end-of-life care decision making in the pediatric ICU that includes directive, value-neutral, and organizational roles. More research is needed to validate these roles. Actively ensuring attention to these roles during the decision-making process could improve parents' experiences at the end of a child's life.

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