Abstract
Communication about the end of a child's life is highly sensitive. Although children may be aware of their prognoses when they are dying, primary caregivers do not always acknowledge the impending deaths to them. How primary caregivers communicate (or avoid communicating) with their children who have life-limiting illnesses about their (or their siblings') illness and impending death may be determined by several factors. A qualitative, semistructured interview study of 19 bereaved and nonbereaved primary caregivers of pediatric patients in palliative care was conducted and interpreted using inductive thematic analysis. Primary caregivers offer various reasons for discussing or refraining from discussion with their children that relate to preparing and protecting them. Primary caregivers communicate with their children about death to prepare them (by acknowledging, enabling, and teaching) or avoid the topic to protect them (and their relationships, emotions, and perceptions). When deciding whether to open discussions about their child's impending death, caregivers draw on parenting skills that parallel those developed while making other decisions for their children.