It is OK to discuss death with a dying child and in fact desirable, Swedish researchers reported.

Parents who talked about death when their children were dying of cancer almost never regretted it, while those who could not bring themselves to raise the issue sometimes wished they had, the survey of 449 parents found.

The findings should reassure anxious parents, doctors said. In recent years, medical groups have urged physicians to be frank with patients about their illness, regardless of age.

"I have seen children with cancer respond to the idea of their dying with startling maturity," wrote Dr. Lawrence Wolfe of Tufts-New England Medical Center in a commentary in the New England Journal of Medicine, where the results also appear.

"A 9-year-old boy left a legacy by giving his prized possessions to his friends, planned his funeral, and decided what he would wear to his burial," he added.

The study found none of the 147 parents who said they talked to their child about death regretted it. But of the 258 parents who did not raise the issue, 27 percent said they wish they had done so.

The regrets were mostly likely to come from parents who had sensed the child had realized he or she was about to die.

Not talking about an imminent death had consequences for the survivors as well. The parents who wished they had not kept silent had twice the risk of depression, said Ulrika Kreicbergs of the Karolinska Institute in Stockholm, who led the study.

She and colleagues found that 21 percent of the parents who did not regret talking to their kids about death had moderate or severe depression. But 48 percent of the parents who wished they had talked with their children about death suffered from moderate to severe depression.

"Perhaps these parents felt that the child was left with his or her thoughts, alone and without comfort," the researchers wrote.

The survey also found that parents were more likely to discuss death if they were religious, if they were older, and if they sensed that the child had realized he or she was about to die.

"Most children (63 percent) were not informed that their illness was incurable," the researchers wrote.

But many children figured it out. Twenty-one percent of the parents said their child sensed when death was still a month or more away, 32 percent of the children seemed to know by the time death was a week away, and 22 percent realized it during the final week.

Reference Source 89
September 16, 2004

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