When a child dies: pediatric oncologists’ follow-up practices with families after the death of their child Leeat Granek 1 *, Maru Barrera 2,3 , Katrin Scheinemann 4,5 and Ute Bartels 6,7 1 Department of Public Health, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer Sheva, Israel 2 Department of Psychology and Hematology/Oncology Program, SickKids Hospital, Toronto, ON, Canada 3 Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada 4 Division of Haematology/Oncology, McMaster Children’s Hospital/McMaster University, Hamilton, ON, Canada 5 Children’s Hospital, Cantonal Hospital, Lucerne, Switzerland 6 Division of Haematology/Oncology, NeuroOncology Program, SickKids Hospital, Toronto, ON, Canada 7 University of Toronto, Toronto, ON, Canada *Correspondence to: Department of Public Health, Faculty of Health Sciences, Ben- Gurion University of the Negev, PO Box 653, 84105, Beer Sheva, Israel. E-mail: Leeatg@ gmail.com Received: 10 April 2014 Revised: 6 January 2015 Accepted: 15 January 2015 Abstract Objectives: Follow-up practices with bereaved families are considered a part of good medical care, yet little is known about pediatric oncologists’ protocol with families when their patients die. The objec- tive of this study was to examine follow-up practices employed by pediatric oncologists after patient death using an in-depth qualitative analysis. Methods: The Grounded Theory method of data collection and analysis was used. Twenty-one pediatric oncologists at two Canadian pediatric hospitals were interviewed about their follow-up practices with bereaved families after patients died. Line-by-line coding was used to estab- lish codes and themes, and constant comparison was used to establish relationships among emerging codes and themes. Results: Pediatric oncologists actively engage in follow-up practices that include making phone calls, sending an email or condolence card, attending funerals or visitations, having long-term and short- term meetings with parents, and attending hospital or departmental memorials for the deceased child. Attending funerals or visitations was less frequent and varied widely across pediatric oncologists. Reasons for not participating in bereavement follow-up practices included logistical, emotional, and practical considerations. Conclusions: While the majority of pediatric oncologists at two Canadian centers engage in some follow-up practices with bereaved families, these practices are complex and challenging because of the emotional nature of these interactions. Medical institutions should provide both structured time for this follow-up work with families, as well as medical education and financial and emotional sup- port to pediatric oncologists who continue caring for these families long after their child has died. Copyright © 2015 John Wiley & Sons, Ltd. Introduction Bereavement follow up for families (e.g., making a tele- phone call, meeting with families, and sending a condo- lence card) who have had a family member die of cancer is considered to be part of good medical care [1] but has received little research attention in the oncology context. The few research studies that have examined oncologists’ follow-up practices with bereaved family members have focused on the adult care context [2–4]. In one study that looked at Israeli adult oncologists, the majority of partici- pants rarely attended bereavement rituals that involved direct contact with families including funerals and visita- tions, 28% occasionally participated in rituals involving direct contact, 45% had some form of indirect contact such as sending a condolence letter, and 34% of the phy- sicians reported ‘frequently’ making a phone call [2]. In a Canadian study examining palliative care and oncology physicians who treat adults, only one-third of medical professionals reported usually, or always making a phone call to families, sending a condolence card, or attending a funeral following a patient’s death; another one-third of them reported never or rarely participating in any bereavement rituals at all [3]. Finally, in a Canadian qualitative study, Granek and colleagues [4] found that adult oncologists had no stan- dard protocol on how to deal with patient deaths in terms of follow up with families. Oncologists turned to a number of ad hoc strategies in dealing with families including phone calls, sending cards, meeting with the family, and/or attending funerals. These practices were found to be rare and did not follow any systematic guidelines [4]. While the recognition of the physician’s responsibility to support parents after the death of a child is not new in Copyright © 2015 John Wiley & Sons, Ltd. Psycho-Oncology Psycho-Oncology (2015) Published online in Wiley Online Library (wileyonlinelibrary.com). DOI: 10.1002/pon.3770