99年行政院衛生署統計惡性腫瘤是1-14歲兒童第二大死亡原因，這些病童及家庭都是極需要末期照護的對象，但國內對於兒童癌症末期照護相關資源及研究卻非常缺乏。國內自2004年起試辦「安寧緩和醫療共同照顧模式計劃」，是兒童癌症末期照護的重要資源，安寧共同照護目的是協助原單位照護末期病人，並評估需求轉介至安寧病房。本研究將兒科病房、安寧共同照護與安寧病房視為兒童癌症末期照護體系，目的是了解：（一）兒童癌症末期照護體系內各單位之照護現況；（二）兒癌末期照護體系之運作；（三）醫護人員體認病童及父母的癌末需求與矛盾；（四）各單位照護過程的困難；（五）對現況改善的建議。本研究採個案研究法，藉由多元資料收集方式，以南部某醫學中心的兒童癌症末期照護服務體系為個案，回顧2009-2011年之兒科病例，搜集曾經歷兒科病房、安寧共同照護及安寧病房的末期照護服務體系之癌症病童資料共得三位，以病童經歷為訪談引導案例，深度訪談病童母親一位、兒科醫護人員七位、安寧共同照護個管師二位及安寧病房醫護人員七位，並收集各單位相關網站、檔案夾及資料庫內容，以歸納分析的手法，統整出體系內各單位末期照護能力、單位間的合作性、照護癌末病童的困難及建議，深入了解兒童癌症末期照護服務體系的運作及照護情形。
研究結果呈現（一）體系內單位照護現況：兒科病房屬綜合急性病房，與安寧病房及安寧共同照護比較下，對癌症末期照護的知識、訓練、經驗及資源都較缺乏，安寧共同照護及安寧病房是包含身心靈三方面，兒科病房因能力、人力及環境的不足，使得照護提供難達理想。（二）體系運作：兒童癌症末期照護服務體系的啟動是源自於小兒科病房照會安寧共同照護協助，經指導與評估後，視情況及需要轉介至安寧病房照護。（三）醫護人員體認病童及父母的癌末需求與矛盾：醫護人員認為病童的需求是「自主隱私需兼顧」，父母的矛盾在於「擔憂嗎啡使用」、「死亡議題難談論」，最終期待是病童平安的往生。（四）各單位照護過程的困難：1.共同困難在於不易與病童溝通；2.兒科病房指出感到本身對「父母情緒難承受」，對病童「往生不順產內疚」，對病房「資源有限難發揮」；3.安寧共同照護主要是在於與病童「互動生澀難建立」、「父母哀傷難消化」；4.安寧病房提出對病童父母「未老先衰難安慰」，照護過程「缺乏經驗壓力大」、「病童惡化感遺憾」。（五）現況改善的建議：各單位建議加強兒科醫護人員對末期照護的知識及技能。
從研究中發現兒科病房是體系運作的起源，故研究建議加強兒童癌症末期照護教育及建立兒童癌症末期個案討論會，促進醫護人員的討論及情緒分享，不但可以增加照護的能力，也可提高對末期照護的敏感度。並納入兒童心理專業人員於體系中，增進專業人員溝通的能力。

Cancer is the leading cause of non-accidental death in childhood. However, the resources and studies about end-of-life care of terminal ill cancer children in Taiwan has been lack. Hospice ward and hospice shared-care are the resources of end-of-life care for terminal ill cancer children. In this study, the construction of cancer children end-of-life care service system consisted of pediatric ward, hospice ward, and hospice shared-care. The study aims to explore the following questions: 1.What were the services provided by the three units? 2. How the system in the units worked out? 3. What were the staffs’ experience to empathize the needs of terminal ill cancer children and their parents? 4. What were the difficulties of the staffs within the system when provided the end-of-care services? 5. What were the suggestions of the staffs within the system provided the end-of-care for the terminal ill cancer children?
Using case study method, the terminal end-of-life care system for terminal ill cancer children in a medical center at south Taiwan was chosen as a case. Researcher picked up three children who had the experience of the combine care among pediatric ward, hospice ward, and hospice shared-care in 2009-2011. The researcher took their care history by chart review. The care history was used as a part of interview guide. There were one child’s mother, seven pediatric staffs, two hospice shared-care staffs, and seven hospice ward staffs were interviewed. Also, documents from the web site, official files, and data base of the three units were collected.
Study results shown: 1. The staffs of pediatric ward had less knowledge, training, experience and resources of terminal ill cancer care than the staffs of hospice ward and hospice shared-care. 2. The initiate care of the service system is the hospice shared-care consultation by pediatric ward. After the assessment and evaluation, they referred the children to hospice ward according to their situation. 3. The staffs thought that the children needed privacy and autonomy, parents worried about using of morphine on children and difficult to discuss death/dying issue with them. 4. The same difficulty of three units was communicating with children. The pediatric ward staffs pointed out it was hard to take care parents’ emotion when facing the children died uncomfortable, which lead the parents feel guilt. They also mentioned the lack of the end-of-life care resources. The hospice shared-care staffs said it was hard to build the relationship with children and it was hard to comfort parents’ sorrow. The hospice ward staffs said it was tough to console with parents, when they felt stressful in the caring process due to lack of experience. They felt sorry when children’s condition getting worse. 5. The suggestions of the three units were enhancing end-of-life care knowledge and skills of the pediatric staffs.
The study suggests that adding education of end-of-life care for terminal ill cancer children to the pediatric staffs and setting up case conference is essential.

中文參考文獻
中央健康保險局（2011年6月2日）．安寧居家療護院所24小時諮詢服務專線．取自http://www.nhi.gov.tw/resource/Webdata/15126_1_安寧居家療護院所名單及24小時諮詢服務專線-第1版1000601.xls [Bureau of National Health Insurance, Taiwan, ROC. (2011, June 2). Palliative home care resources 24hrs service hotline. Retrieved from http://www.nhi.gov.tw/resource/Webdata/15126_1_安寧居家療護院所名單及24小時諮詢服務專線-第1版1000601.xls]
台灣安寧照顧協會（2011年8月2日）．台灣地區安寧療護資源分佈現況．取自http://www.tho.org.tw/xms/content/show.php?id=344 [ Taiwan Hospice Organization, (2011, August 2). Palliative care resource distribution in Taiwan. Retrieved from http://www.tho.org.tw/xms/content/show.php?id=344]
台灣安寧緩和醫學學會（2007）．安寧緩和醫療：理論與實務．台北：新文京開發。[ Taiwan Academy of Hospice Palliative Medicine, (2007). Hospice Palliative care-Theory and Practice. Taipei City, Taiwan, ROC: New Wun Ching Developmental Publishing]
安寧照護基金會（2006）．安寧居家療護設置規範．取自http://www.hospice.org.tw/2009/chinese/hospital-4.php [Hospice Foundation of Taiwan, (2006). Palliative home care setting standard. Retrieved from http://www.hospice.org.tw/2009/chinese/hospital-4]
行政院衛生署（2009）．新增八類非癌症重症末期病患也能接受安寧療護服務．取自http://www.doh.gov.tw/CHT2006/DM/SEARCH_RESULT.aspx [Department of Health, Executive Yuan, Taiwan, ROC. (2009). Add eight non cancer terminal illnesses to palliative care services. Retrieved from http://www.doh.gov.tw/CHT2006/DM/SEARCH_RESULT.aspx]
行政院衛生署（2011）．衛生統計系列（一）死因統計-99年度死因統計．取自http://www.doh.gov.tw/CHT2006/DM/DM2_2_p02.aspx?class_no=440&now_fod_list_no=11468&level_no=1&doc_no=77184 [Department of Health, Executive Yuan, Taiwan, ROC. (2011). Health Statistics (1) cause of death statistics- 2010 cause of death statistics. Retrieved from http://www.doh.gov.tw/CHT2006/DM/DM2_2_p02.aspx?class_no=440&now_fod_list_no=11468&level_no=1&doc_no=77184]
呂季紋、黃棣棟、穆佩芬（2011）．護理人員照顧癌症病童臨終時的經驗．護理雜誌．58（4），37-46。[Lu, C. W., Wong T. T., & Mu P. F. (2011). Providing end-of-life nursing care to children with cancer. The Journal of Nursing, 58(4), 37-46.]
沈青青、林妙伶、許婷秀、齊珍慈（2008）．醫護人員及家屬對兒童安寧緩和照護需求滿意度之探討．榮總護理，25（3），206-214。[Sheng, C. C., Lin, M. L., Hsu, T. S., & Chi, C. T. (2008). Preliminary study of needs and satisfaction toward hospice palliative care of the medical personnel and family in pediatric wards. Velerens General Hospital Nursing, 25(3), 206-214.]
沈青青（2006）．兒童安寧緩和照護．社團法人國際護理榮譽學會中華民國分會會訊，26。[Sheng, C. C. (2006). The newsletter of children palliative care. The Honor Society of Nursing, Sigma Theta Tau International, Lambda Beta-at-Large Chapter in Taiwan, ROC., 26.]
林佩璇（2005）．個案研究其在教育研究上的應用．於中正大學教育研究所主編 ，質的研究方法（239-263頁)．高雄：麗文。[Lin, P. S. (2005). Apply case study on education research. In National Chung Cheng University Graduate Institute of Education (Ed.), Research method of qualitative(pp. 239-263). Kaohsiung City, Taiwan, ROC: Liwen Publishing Group]
姚建安、邱泰源、胡文郁、陳慶餘（2005）．安寧緩和醫療的知識、態度和臨床技能的探討．安寧療護雜誌，10（2），139-145。[Yao C. A., Chiu T. Y., Hu W. Y., & Chen C. Y. (2005). Knowledge, attitude and clinical skill of family physicians toward the hospice palliative care. Taiwan Journal of Hospice palliative Care, 10(2), 139-145.]
胡幼慧（2009）．質性研究：理論、方法及本土女性研究實例．台北：巨流。[Hu, Y. H. (2009). Qualitative research: Theory, method and research of local female. Taipei City, Taiwan, ROC: Chuliu Publisher.]
翁芝爾、陳淑賢、廖美南、王正旭（2005）．非安寧病房護理人員對安寧療護知識及態度之初探．長庚護理，16（1），12-22。[Weng, C. E., Chen S. H., Liao, M. N., & Wang C. H. (2005). Preliminary study of knowledge and attitude toward hospice care among nurses in non-hospice ward. Chang Gung Nursing, 16(1), 12-22.]
莊榮彬（2005）．安寧共同照顧簡介．安寧療護雜誌，10（1），39-43。[Chuang R. B. (2005). Introduction of hospital-based palliative shared care program. Taiwan Journal of Hospice Palliative Care, 10(1), 39-43.]
許正眉、蔡佩渝（2009）．某醫學中心安寧緩和醫療會診後續追踪分析．安寧療護雜誌，14（3），275-283。[Hsu, J. M., & Tsai P. Y. (2009). Follow-up study of hospice palliative care consultation in a medical center. Taiwan Journal of Hospice palliative Care, 14(3), 275-283.]
許芳瑜（2010）．加護單位護理人員照顧病人及家屬於瀕死過程之敘說（未發表的碩士論文）．台南：成大。[Hsu, F. Y. (2010). Narratives of the ICU nurses caring for patients and families during the dying process (Unpublished master’s thesis). Tainan City, Taiwan, ROC: Department of Nursing, College of Medicine, National Cheng Kung University.]
許馨文、胡文郁、程劭儀、姚建安、陳慶餘、邱泰源（2005）．某緩和病房小兒癌末病人善終服務．安寧療護雜誌，10(4)，358-370。[Hsu, H. W., Hu, W. Y., Cheng, S. Y., Yao, C. A., Chen, C. Y., & Chiu, T. Y. (2005). Good death assessment of pediatric patients with Terminal Cancers at a Palliative Care Unit. Taiwan Journal of Hospice palliative Care, 10(4), 358-370.]
陳李綢（2007）．個案研究理論與實務．臺北：心理。[Chen, L. C. (2007). Case study theory and application. Taipei City, Taiwan, ROC: Psychological Publishing.]
陳雅惠（2006）．中部某醫學中心之護理人員的臨終兒童照護經驗．（未發表的碩士論文）．台北：台灣大學。[Chen, Y. H. (2006). Nurses’ experiences of caring for terminally ill children at a medical center in central Taiwan. (Unpublished master’s thesis). Taipei City, Taiwan, ROC: Department of Nursing, College of Medicine, National Taiwan University.]
陳雅惠、陳月枝、駱麗華、林東燦、王建得（2008）．兒科急重症病房護理人員照護臨終兒童之困境．長庚護理，19（4），450-460。[Chen, Y. H., Chen, Y. C., Lo, L. H., Lin, D. T., & Wang, J. D. (2008). Acute pediatric nursing barriers of caring for terminally ill children. Chang Gung Nursing, 19(4), 450-460.]
黃玉苹、陳月枝、陳雅惠（2009）．非安寧病房護理人員照護臨終病童之困難經驗．澄清醫護管理雜誌，5（4），30-38。[Huang, Y.P., Chen Y. C., Chen Y. H. (2009). The experience of difficulties of pediatric nurses caring for dying children in non-palliative care units. Cheng Vhing Medical Journal, 5(4), 30-38.]
黃建勳、姚建安、邱泰源、王浴、陳慶餘（2005）．安寧病房入住需求與資源分配研究．安寧療護雜誌，10（1），1-12。[Huang, C. H., Yao, C. A., Chiu, T. Y., Wang, Y., & Chen, C. Y. (2005). Analysis of need and resource distribution for admission to hospice ward. Taiwan Journal of Hospice Palliative Care, 10(1), 1-12.]
黃建勳、胡文郁、姚建安、邱泰源、呂碧鴻、陳慶餘（2006）．安寧緩和醫療之初次照會．台灣醫學，10（6），667-674。[Huang, C. H., Hu, W. Y., Yao, C.A., Chiu, T. Y., Lue, B. H., & Chen, C. Y. (2006). Initial consultation for hospice palliative care. Formosan Journal of Medicine, 10(6), 667-674.]
葉重新（2001）．教育研究法．台北：揚智文化。[Yeh, G. X. (2001). Research method of education. Taipei City, Taiwan, ROC: Yang Chih Book.]
趙可式（2001）．讓我靠近你-認識兒童安寧療護．安寧照護會訊，40，13-16。[Chao, C. S. (2001). Let me close to you-understanding palliative care of children. The Newsletter of Hospice Foundation of Taiwan, 40, 13-16.]
趙可式（2007）．安寧伴行．台北：天下遠見出版股份有限公司。[Chao, C. S. (2007). Stay with palliative care. Taipei City, Taiwan, ROC: Global Views Publisher.]
蔡甫昌、林之宇、張至寧（2008）．研究倫理的歷史、原則與準則．臺灣醫學， 12（1），107-122。[Tsai, F. C., Lin, C. Y., & Chang, C. N. (2008). Research ethics: History, principles and guidelines. Formosan Journal of Medicine, 12(1), 107-122.]
蔡昌雄、蔡淑玲、劉鎮嘉（2006）．死亡焦慮下的自我照顧-以安寧護理人員為例．生死學研究．（3），133-164。[Tsai, C. H., Tsai, S. L., & Liu, C. J. (2006). Self-care under death anxiety: take hospice nurses as example. Journal of Life-and-Death Studies. (3), 133-164.]
盧璧珍、張靜安、白玉珠、蔡欣玲（2008）．護理人員面對死亡事件的心理反應與處理方式．榮總護理，25（3），268-275。[Lu, P. C., Chang, J. A., Pai, Y. C., & Tsai, S. L. (2008). A study of psychological response and manage-ment of the clinical nurses dealing with death. Velerens General Hospital Nursing, 25(3), 268-275.]
賴允亮（2004）．台灣之安寧緩和醫療．台灣醫學．8（5），653-656。[Lai, E. Y. (2004). Hospice palliative care in Taiwan. Formosan Journal of Medicine, 8(5), 653-656.]
藍育慧、趙淑員、陳淑齡、莊照明、郭容美（2007）．非安寧單位護理人員安寧認知、死亡恐懼與情緒困境之探討．安寧療護雜誌，12（2），156-171。[Lan, Y. H., Chao, S. Y., Chen, S. L., Chuang C. M., & Kuo, J. M. (2007). An Exploration of the non-hospice care unite nursing staff’s cognition of hospice care, fear of death and emotional distress. Taiwan Journal of Hospice palliative Care, 12(2), 156-171.]
Burns, N., & Grove, S. K. (2002)．實用護理研究：指引、評論及運用（陳桂敏、鄭靜瑜、曾月霞、顧雅利、謝惠玲、王靜枝…郭素珍譯）．台中：滄海（原著出版於2001）[Burns, N., & Grove, S. K. (2002). The practice of nursing research : Conduct, critique and utilization, (K. M. Chen, C. Y. Cheng, Y. H. Tseng, Y. L. Ku, H. L. Xie, ... S. C. Kuo, Trans.). Taichung City, Taiwan, ROC: Tsang Hai Book Publishing. (Original work published 2001)]
Jane R., & Jane L. (2008)．質性研究方法（藍毓仁譯）．台北：巨流（原著出版於2003）[Jane R., & Jane L. (2008). Qualitative research practice: A guide for social science students and researcher, (U. J. Lan, Trans.). Taipei City, Taiwan, ROC: Chuliu Publisher. (Original work published 2003)]
Yin, R. K. (2009)．個案研究設計與方法（周海濤、李永賢、張蘅譯）．台北：五南（原著出版於2003）[Yin, R. K. (2009). Case study research design and methods, (H. T. Zhou, W. Y. Li, & H. Zhang, Trans.). Taipei City, Taiwan, ROC: Wu-Nan culture enterprise. (Original work published 2003) ]

英文參考文獻
Addicott, R., & Ross, S. (2010, December 11). Implementing the end of life care strategy: Lessons from good practice. Retrieved from http://www.kingsfund.org.uk/publications/implementing_the_end.html
Armstrong, D. A., & Zarbock, S. (2006). Hospice care for children (2nd Ed). New York: Oxford University Press.
Baverstock, A., & Finlay, F. (2006). Specialist registrars' emotional responses to a patient's death. Archives of Disease in Childhood, 91(9), 774-776. doi: 10.1136/adc.2005.076760
Beauchamp, T. L., & Childress, J. F. (2009). Principles of biomedical ethics (6 ed.). New York: Oxford University Press.
Beckstrand, R. L., Callister, L. C., & Kirchhoff, K. T. (2006). Providing a "good death": Critical care nurses' suggestions for improving end-of-life care. American Journal of Critical Care, 15(1), 38-45.
Benini, F., Spizzichino, M., Trapanotto, M., & Ferrante, A. (2008, December 1). Pediatric palliative care. Italian Journal of Pediatrics, 34(4), Retrieved from: http://www.ijponline.net/content/34/1/4. doi: 10.1186/1824-7288-34-4
Billings, J., Jenkins, L., & Black, R. (2011). A learning and development strategy for children's hospices accross London. International Journal of Palliative Nursing, 17(10), 483-491.
Brandon, D., Docherty, S. L., & Thorpe, J. (2007). Infant and child deaths in acute care settings: implications for palliative care. Journal of Palliative Medicine, 10(4), 910-918. doi: 10.1089/jpm.2006.0236
Brown, E. (2007). The historical background of paediatric palliative care. In E. W. Brown, B (Ed.), Supporting the child and the family in paediatric palliative care (pp. 18-25). London and Philadelphia: Jessica Kingsley Publishers.
Cole, L. (2003). Say when end-of-life decisions in PICU. Journal of Pediatric Nursing, 19(2), 138-143.
Contro,N.A., Larson, J., Scofield, S., Sourkes, B., & Cohen, H. J. (2004). Hospital staff and family perspectives regarding quality of pediatric palliative care. Pediatrics, 114(5), 1248-1252. doi: 10.1542/peds.2003-0857-L
D'Agostino, N. M., Berlin-Romalis, D., Jovcevska, V., & Barrera, M. (2008). Bereaved parents' perspectives on their needs. Palliative and Supportive Care, 6, 33-41. doi: 10.1017/S1478951508000060
Dale, A. E. (1995). A research study exploring the patient’s view of quality of life using the case study method. Journal of Advanced Nursing, 22(6), 1128-1134.
Davies, B., Sehring, S. A., Partridge, J. C., Cooper, B. A., Hughes, A., Philp, J. C., . . . Kramer, R. F. (2008). Barriers to palliative care for children: perceptions of pediatric health care providers. Pediatrics, 121(2), 282-288. doi: 10.1542/peds.2006-3153
Deffner, J. M., & Bell, S. K. (2005). Nurses' death anxiety, comfort level during communication with patients and families regarding death, and exposure to communication education: A quantitative study. Journal for Nurses in Staff Development, 21(1), 19-23.
DeSpelder, L. A., & Strickland, A. L. (2005). Health care systems: Patients, staff, and institutions. The last dance: Encountering death and dying. (7th ed., pp. 125-152). Boston: McGraw-Hill.
Doyle, D. O., Hanks, G., Cherny, N. I., & Calman, S. K. (2004). The challenge of palliative medicine. In D. Doyle (Ed.), Palliatvie medicine (3rd ed., pp. 7-51). New York: Oxford.
Feldstein, M. A., & Gemma, P. B. (1995). Oncology nurses and chronic compounded grief. Cancer Nursing, 18(3), 228－236.
Gangeness, J. E., & Yurkovich, E. (2006). Revisiting case study as a nursing research design. Nurse Researcher, 13(4), 7-18.
Goldman, A., Hain, R., & Liben, S. (2006). Education and training. In L. M. Fergusion, S. Fowler-Kerry & R. Hain (Eds.), Palliative care for children (pp. 594-614). New York: Oxford University Press.
Help the Hospices (2011). About hospice care. Retreved from http://www.helpthehospices.org.uk/hospiceinformation/
Herd, E. (2005). Quality assessment in children’s hospice care. Pediatric Nursing, 17(3), 20-23.
Higginson, I. J., Finlay, I., Goodwin, D. M., Cook, A. M., Hood, K., Edwards, A. G. K., . . . Norman, C. E. (2002). Do hospice-based palliative teams improve care for patients or families at the end of care? Journal of Pain Symptom Management, 23(2), 96-106.
Higginson, I. J., Finlay, I., Goodwin, D. M., Hood, K., Edwards, A. G. K., Cook, A. M., . . . Norman, C. E. (2003). Is there evidence that palliative care teams alter end-of-life experience of patients and their caregivers? Journal of Pain Symptom Management, 25(2), 150-168.
Himelstein, B. P., Hilden, J. M., Boldt, A. M., & Weissman, D. (2004). Pediatric palliative care. The New England Journal of Medicine, 350(17), 1752-1762.
Hinds, P. S., Oakes, L. L., Hicks, J., & Angelescu, D. L. (2005). End of life care for children and adolescents. Seminars in Oncology Nursing, 21(1), 53-62.
Jalmsell, L., Kreicbergs, U., Onelöv, E., Steineck, G., & Henter, J. I. (2006). Symptoms affecting children with malignancies during the last month of life: a nationwide follow-up. Pediatrics, 117(4), 1314-1320.
Jensen, J. L., & Rodgers, R. (2001). Cumulating the intellectual gold of case study research. Public Administration Rview, 61(2), 235-246. doi: 10.1111/0033-3352.00025
Kapo, J., Harrold, J., Carroll, J. T., Rickerson, E., & Casarett, D. (2005). Are we referring patients to hospice too late? Patients' and families' opinions. Journal of Palliative Medicine, 8(3), 521-527.
Kinzbrunner, B. M., Weinreb, N. J., & Policzer, J. S. (2002). 20 common problems in end of life care. New York: McGraw-Hill.
Korones, D. N. (2007). Pediatric palliative care. Pediatrics in Review, 28(8), e46-e56. doi: 10.1542/pir.28-8-e46
Kreicbergs, U., Valdimarsdóttir, U., Onelöv, E., Henter, J., &Steineck,G. (2004). Talking about death with children who have severe malignant disease. The New England Journal of Medicine, 351(12), 1175-1186.
Malcolm, C., Forbat, L., Knighting, K., & Kearney, N. (2008). Exploring the experiences and perspectives of families using a children's hospice and professionals providing hospice care to identify future research priorities for children's hospice care. Palliative Medicine, 22(8), 921-928. doi: 10.1177/0269216308098214
Malloy, P., Ferrell, B., Virani, R., Wilson, K., & Uman, G. (2006). Palliative care education for pediatric nurses. Pediatric Nursing, 32(6), 555-561.
McCarron, A. (1995). Stress in cancer care and coping strategies. . Nursing Times, 91(4), 11-12.
McCarthy, P., Chammas, G., & Wilimas, J. (2004). Managing children’s cancer pain in Morocco. Journal of Nursing Scholarship, 36(1), 11-15.
Meyer, E. C., Ritholz, M. D., Burns, J. P., & Truog, R. D. (2006). Improving the quality of end-of-fife care in the pediatric intensive care unit: Parents’ priorities and recommendations. Pediatrics, 117(3), 649-657. doi: 10.1542/peds.2005-0144
Michelson, K. N., & Steinhorn, D. M. (2007). Pediatric end-of-life issues and palliative care. Clinical of Pediatric Emergency Medicine, 8(3), 212-219.
Monterosso, L., & Kristjanson, L. J. (2008). Supportive and palliative care needs of families of children who die from cancer: An Australian study. Palliative Medicine, 22(1) 59-70.
Papadatou, D., Martinson, I. M., & Chung, P. M. (2001). Caring for dying children: A comparative study of nurses’ experiences in Greece and Hong Kong. Cancer Nursing, 24(5), 402－412.
Pritchard, M., Burghen, E., Srivastava, D. K., Okuma, J., Anderson, L., Powell, B., . . . Hinds, P. S. (2008). Cancer-related symptoms most concerning to parents during the last week and last day of their child's life. Pediatrics, 121(5), e1301-1309. doi: 10.1542/peds.2007-2681
Reynolds, M. (2002). Reflecting on pediatric oncology nursing practice using Benner’s Helping Role as a framework to examine aspects of caring. European Journal of Oncology Nursing, 6(1), 30-36.
Rickerson, E., Harrold, J., Kapo, J., Carroll, J. T., & Casarett, D. (2005). Timing of hospice referral and families' perceptions of services: Are earlier hospice referrals better? Journal of American Geriatrics Society, 53(5), 819-823.
Sasahara, T., Miyashita, M., Umeda, M., Higuchi, H., Shinoda, J., Kawa, M., & Kazuma, K. (2010). Multiple evaluation of a hospital-based palliative care consultation team in a university hospital: Activities, patient outcome, and referring staffs view. Palliative and Supportive Care, 8(1), 49-57.
Shah, A., Diggens, N., Stiller, C., Murphy, D., Passmore, J., & Murphy, M. F. (2011). Place of death and hospital care for children who died of cancer in England, 1999-2006. European Journal of Cancer, 47(14), 2175-2181. doi: 10.1016/j.ejca.2011.03.030
Tang, S. T., Hung, Y. N., Liu, T. W., Lin, D. T., Chen, Y. C., Wu, S. C., & Hsu, T. H. (2011). Pediatric end-of-life care for Taiwanese children who died as a result of cancer from 2001 through 2006. American Society of Clinical Oncology, 29(7), 890-894. doi: 10.1200/JCO.2010.32.5639
Taylor, L. K., Miller, M., Joffe, T., Parslow, R. C., Aldridge, J., Bailey, C. C., & McKinney, P. A. (2010). Palliative care in Yorkshire, UK 1987-2008: Survival and mortality in a hospice. Archives of Disease in Childhood, 95(2), 89-93. doi: 10.1136/adc.2009.158774
Teno, J. M., Shu, J. E., Casarett, D., Spence, C., Rhodes, R., & Connor, S. (2007). Timing of referral to hospice and quality of care: Length of stay and bereaved family members' perceptions of the timing of hospice referral. Journal of Pain and Symptom Management, 34(2), 120-125.
Ward- Smith, P., Linn, J. B., Korphage, R. M., Christenson, K., & Hubble, C. L. (2007). Development of a pediatric palliative care team. Journal of Pediatric Health Care, 21(4), 245-249.
WHO. (2011). Palliative Care. Retreved from http://www.who.int/cancer/palliative/en/
Wolfe, J., Grier, H. E., Klar, N., Levin, S. B., Ellenbogen, J. M., Salem-Schatz, S., . . . Weeks, J. C. (2000). Symptoms and suffering at the end of life in children with cancer. The New England Journal of Medicine, 342(5), 326-333.
Yin, R. K. (2009). Case study research: Design and methods (4th ed.). Thousand Oaks: Sage Publications
Zhukovsky, D. S., Herzog, C. E., Kaur, G., Palmer, J. L., & Bruera, E. (2009). The impact of palliative care consultation on symptom assessment, communication needs, and palliative interventions in pediatric patients with cancer. Journal of Palliative Medicine, 12(4), 343-349.