Personal and professional experiences of pediatric residents concerning death

Background: The American Academy of Pediatrics (AAP) statement on Pediatric Palliative Care has emphasized the importance of identifying barriers and facilitators to effective palliative care. Objectives: To survey pediatric residents about their personal and professional experiences concerning death and determine factors associated with guilt (a potential barrier) and attendance at patient funerals (a potential facilitator). Design/methods: PL-2 residents were surveyed midway through pediatric residency. Both personal and professional attitudes and experiences about death were solicited. Results: Seventy-nine (90%) PL-2 residents completed the survey from 1997-2000. While 91% reported that a close family member or friend had died, 75% recalled that their family had not openly discussed issues of death. Thus far in their career, residents reported encountering a mean of 9.4 patients who had died (±6.4; range, 0-30 deaths) and 39% expressed guilt about a death. Those who felt guilt about a death were more likely to state they felt responsible (p < 0.01) but less likely to think about their own death (p < 0.01). While 23% had attended a patient's funeral, 42% expressed fear of attending. The mean number of times a resident informed a family of a patient's death was slightly higher in those who attended a patient's funeral, and approached statistical significance. Conclusions: By midresidency, these pediatric residents have had many personal and professional experiences with death. Residency training programs must provide venues for residents to address bereavement, facilitate the integration of these experiences, and provide time to attend funerals.