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Elena M. Andresen, PhD; Grace A. Seecharan, MPH; Suzanne S. Toce, MD

Arch Pediatr Adolesc Med. 2004;158:430-435.

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 ) 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.

From the Department of Community Health, Salus Center, School of Public Health (Dr Andresen and Ms Seecharan), and Department of Pediatrics, Saint Louis University (Dr Toce), and SSM Cardinal Glennon Children's Hospital (Dr Toce), St Louis, Mo.

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