Setting of the Childs Death

Some families have the opportunity to plan ahead and choose a setting for their child's death—home, hospice, or hospital. The child may express a preference about where he or she feels safe or prefers to be. Clear information about how the child is likely to die and professional support to validate the family's choice are crucial. Even more important is the explicitly stated "permission" from all members of the professional team that the family may change their choice freely at any time—that all options remain open and that no decision is irrevocable.

Although in the current culture of palliative care, having children die at home is strongly advocated, the actual place of death may be less important than previously thought (Dussel et al. 2009). Rather, dying in the family's preferred location may be the more critical variable. In fact, Dussel et al. (2009) found that the opportunity to plan for a child's location of death was associated with parental perceptions of high-quality end-of-life care. Thus, although beneficial effects have been associated with a child's home death (Goodenough et al. 2004; Lauer et al. 1989), professionals must bear in mind that for some children and families, the hospital is a better option, and that choice must be respected.

As a child's and family's mental health needs continue beyond a transition to home or hospice, the mental health clinician is likely to meet with them in alternative settings, outside of the hospital or clinic. Although psychosocial support is often provided as a component of hospice care, this does not replace the therapeutic benefit of ongoing contact with the mental health clinician who has known the child and family before the end-of-life phase. Continuity of care serves to minimize a sense of abandonment when contact with the hospital staff and physicians is greatly reduced.

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