| Support Targets | Support Contents | No. | ||
| Category | Subcategory | Code | ||
| 1) For support provided to children | Effective Instruction of Communication Techniques with Surviving Family | Maintaining interactions between parent and child to uphold their bond | Legacy work (letters, photos, tangible objects, future plans) to maintain the parent-child bond after the parent’s death | 1 |
| Encourage open communication with the family | Open communication with their family will be reduces the risk of long-term grief symptoms in children | 5 | ||
| Positive Provision of Information Regarding Parental End-of-Life Care | Positive information about parental end-of-life care | Providing information to children about their parent’s inevitable death | 6 | |
| Making positive plans for the future, addressing realistic and financial matters | ||||
| Maintaining everyday life as much as possible, creating memories while utilizing social networks as needed | ||||
| Support Provided by Multidisciplinary Teams | Support provided by multidisciplinary teams | Many families tend to be hesitant to discuss the illness with their children, children prefer to receive explanations about their parent’s illness rather than being left out | 8 | |
| All professionals involved with the family have a role to play in ensuring that they can participate in discussions and information sharing to the extent desired by the child | ||||
| Providing continuous care and maintaining contact with the family after bereavement can serve as a source of support for the child | ||||
| Support for Overcoming Grief | Support for Overcoming Grief | Immediately after the death of a parent, it is crucial to utilize family-centered bereavement support groups, providing support and practical guidelines to both single parents and children. Peer support was deemed necessary to normalize the grieving experience and promote hope for the future | 11 | |
| Receiving family support services to meet others who had undergone similar experiences, as this provided opportunities to listen to others’ stories, gain insight into how to overcome milestones after the parent’s death, and facilitate dialogue among children | ||||
| Recognizing that other children had also lost parents provided hope for the future through shared experiences | ||||
| Sharing concerns about children’s well-being with teachers at school when there are worries about the children proved to be beneficial for both the children’s safety and the reassurance of the bereaved family | ||||
| Discussing the deceased parent within the family was important. For many bereaved families, it was crucial to continue family interactions to ensure that children did not forget about the deceased parent | ||||
| 2) For support provided to families | Encouraging Families on How to Communicate the Dying Process of a Parent to Children | Encouraging Families on How to Communicate the Dying Process of a Parent to Children | There is no “appropriate time” to tell children, but it is best to have such difficult conversations when children have time to understand the severity of the prognosis | 6 |
| “When it is optimal to tell children”, should regarding when parents have time to understand and accept the illness themselves, and to convey this information when they are physically capable | ||||
| “Location for the conversation”, should choose a time and place where the parent’s conversation will not be interrupted, to talk slowly with the child, and to create an environment where emotions can be expressed and after talking to the child, it was recommended for parents to plan family events that are not burdensome, such as going for a walk | ||||
| Regarding “who should convey the information to the children”, parents, who know their children best, are the ones who should communicate with them | ||||
| Provide honest information to children about the parent’s prognosis and inevitable death, as well as to make positive plans for the future, maintain daily life as much as possible, and create memories while utilizing social networks as needed | ||||
| Using age-appropriate, clear, and fact-based language, avoiding euphemistic expressions when discussing “what words are appropriate”. | ||||
| Discuss explanations with the family according to the situation | Parents need to consider what children can and cannot handle, and that not informing children about the situation indicates the difficulty in expressing their grief | 10 | ||
| Regarding the emotional expressions of the ill parent, it was stated that the remaining parent has a responsibility to explain their behavior to the child | ||||
| Facilitating Communication about the Deteriorating Condition of the Dying Parent to Children | Promoting communication to maintain the bond between parent and child after the parent’s death | Deepening family knowledge about parenting in the terminal stage is crucial as effective support for the entire family in preparation for losing a significant family member | 1 | |
| Methods such as legacy work (utilizing letters, photographs, tangible items, and future plans) were indicated as necessary to maintain the bond between parent and child after the parent’s death | ||||
| In families with children who have a terminally ill parent, having open communication between children and family members enables smooth everyday life after the parent’s death | ||||
| The understanding of the prognosis by the remaining spouse and children | 38% of mothers with illnesses did not inform their children about their imminent death, and 26% did not feel peaceful about dying, with 90% of fathers worrying about the burden on their children after the spouse’s death | 3 | ||
| Clear communication between wives and doctors regarding prognosis | ||||
| Only half of the fathers reported saying goodbye to their wives and children during the last few weeks of life, with spouses who received hospice services having a higher rate of saying goodbye to each other before the wife’s death | ||||
| Fathers indicated that clear communication between doctors and wives regarding prognosis was also related to saying goodbye to spouses and children | ||||
| Support to facilitate family bonding at EOL | Fathers considered raising children in a way that reflected the intentions of the sick mother, discussing whether and how to talk to children about the mother’s death, and how the mother wanted to be remembered as the most crucial communication at the EOL | 4 | ||
| Fathers who reported that the terminally ill mother worried about the children tended to prioritize parenting reflecting the mother’s intentions | ||||
| Supporting the communication of the single parent at EOL, medical professionals could promote bonding between family members | ||||
| The anguish of single parents in conveying the parent’s condition to children | Informational leaflets or educational lectures on communication with children | 7 | ||
| Support from healthcare professionals about death and dying was crucial in facilitating communication with children | ||||
| As family needs progressed, there was a need for medical professionals to enhance their ability to adjust | ||||
| Support Provided by Multidisciplinary Teams | Support provided to families with children who have lost a parent | The most common type of support provided to families was through written materials, with over 90% provided before and after the death of a parent. Individual face-to-face consultations were in the late 80s to early 90s percentile, and web-based support guidance was in the late 80s percentile, with significantly more support provided after the death of the parent than before | 2 | |
| They were more involved before the death than after, while psychologists and psychiatrists were the least involved professionals in providing support | ||||
| Over 80% of hospices supported both partners and their children before and after the parent’s death | ||||
| Support for the continuation and enhancement of communication between parent and child | Needed more specialized support to enhance communication between the single parent and the child | 5 | ||
| Support for children and families by community practitioners | Involving children in conversations about their parent’s illness or bereavement not only respects the child’s perspective but also helps them find meaning in what is happening | 8 | ||
| Ensuring that children can participate in discussions and information-sharing to the extent they desire | ||||
| Community practitioners have an important role here and need to nurture, develop, and labor them | ||||
| The ability to maintain contact with the family even after the parent’s death was highlighted, which contributes to providing ongoing care and becoming a source of support for children | ||||
| Support for Overcoming Grief | Support for parents or single parents to overcome the end-of-life experience | Encouragement should be given to both parents to prepare for the prognosis immediately after receiving a poor prognosis. This includes conveying to children the reality of their parent’s poor prognosis, the inevitability of death, and managing realistic and economic matters for the future | 9 | |
| Healthcare providers were noted to play a crucial role in facilitating such preparation by providing information surrounding the reality of the parent’s poor prognosis and simultaneously offering necessary information to children as death approaches, using age-appropriate language | ||||
| Peer support for surviving families | Family-centered bereavement support groups and encouraging peer support, which helps normalize the grieving experience and foster hope for the future | 11 | ||
| Meeting others who had experienced similar situations and gained insights into how to overcome milestones after the parent’s death by listening to others’ stories | ||||
| Recognition of the presence of other children who had lost parents through dialogue among children | ||||
| Sharing their concerns about their children with teachers at school | ||||
| Continuing communication about the deceased parent within the family |