Date of Award

Fall 1-1-2025

Document Type

Dissertation

Degree Name

Doctor of Philosophy (PhD)

Department

Nursing

First Advisor

Feder, Shelli

Abstract

The first two years after a child’s death, defined by parents as early bereavement, are a particularly vulnerable period for parents. More than 40% of bereaved parents report severe, prolonged grief symptoms during early bereavement. High-quality parent-clinician communication, which is delivered honestly, clearly, and with sensitivity, helps parents make informed decisions about medical care, address their complex needs during their child’s end-of-life (EOL), and is related to lower severity of prolonged grief symptoms many years after a child’s death. However, research rarely focuses on the parent experience in early bereavement, and little is known about which specific components of parent-clinician communication influence EOL preparedness and parental grief. Therefore, the purpose of this dissertation, using an explanatory sequential mixed methods design, was to examine the influence of parent-clinician communication on parental preparedness for EOL care, grief, and social functioning during the early bereavement period among parents who lost their child to cancer. The findings of this dissertation are presented in three manuscripts. The first manuscript, “Prognostic Communication Between Parents and Clinicians in Pediatric Oncology: An Integrative Review,” synthesized the existing literature on prognostic communication in pediatric oncology and identified knowledge gaps that few studies measured prognostic communication during early bereavement, during which parents can reflect on the full course of prognostic communication, and no studies had examined the impact of prognostic communication on parental grief during early bereavement. These knowledge gaps highlight the need for further research. The second manuscript, “Parent-clinician communication and prolonged grief in parents whose child died from cancer,” reported our quantitative findings. Specifically, prognostic information could reduce prolonged grief symptoms by preparing parents for their child’s EOL. In the third manuscript, titled “Preparing for a Child’s End of Life: Parent Perspectives,” we synthesized parents’ perspectives on what it means to prepare for a child’s EOL and delineated perceived barriers and facilitators to preparedness. The results of this three-manuscript dissertation highlight the critical role of high-quality prognostic communication in enhancing EOL preparedness and, in turn, mitigating parental grief. This dissertation provides foundational evidence to guide the development of a validated questionnaire for assessing EOL preparation and to inform the design of interventions that enhance parental preparation during the EOL.

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