132 - A Mixed-Methods Evaluation of Bereavement Expression Systems within a Pediatric Residency Program

Publication Number: 4129.132

Abigail H. Belser, Columbia University Vagelos College of Physicians and Surgeons, New York, NY, United States; Hadley Bloomhardt, Dana-Farber Cancer Institute/Boston Children's Hospital, Boston, MA, United States; Emma Haley, Boston Children's Hospital, Boston, MA, United States; Ashley A. Pollicelli, Boston Childrens Hospital - - Boston, MA, Brookline, MA, United States

Background: Bereavement expression is an important aspect of medical care benefiting both families and clinicians. Pediatric residents face unique emotional challenges after patient deaths, yet they often lack formal training and structured opportunities for bereavement expression. A previous quality improvement project to increase resident engagement in bereavement expression led to greater participation, but reached less than 30% of targeted trainees. These findings highlight the need to better understand how pediatric residents experience grief after patient death and what support is most helpful.

Objective: To explore how pediatric residents experience grief after patient loss and identify barriers surrounding bereavement expression, and to use these insights to guide development of a resident-centered bereavement expression program.

Design/Methods: This mixed-methods, hypothesis-generating study used an anonymous REDCap survey and semi-structured 1:1 interviews. The study population included pediatric residents (PGY1–PGY5) at a large tertiary children’s hospital (n=182). Grant funding supported recruitment efforts. Residents who participated received pens or a meal. The survey included 13 items assessing comfort, participation, barriers, and perceived impact of bereavement expression. Semi-structured interviews were conducted via Zoom and transcribed. Transcriptions were uploaded into DeDoose software. Two coders (AB, HB) analyzed the transcripts until thematic saturation was achieved (n=9) and analyzed using inductive thematic analysis.

Results: A total of 67 out of 182 residents (36.8%) completed the survey. Most (84%) had cared for a patient who died during residency. Only 42% felt comfortable processing their grief. Nearly all (94%) reported that residency’s emotional demands often affected their ability to process loss. A majority (76%) agreed that residency should include a structured bereavement curriculum. Qualitative analysis is in process. Six overarching themes have emerged thus far: barriers to grief expression, desired connection to the patient and the patient’s family, appreciation of shared processing, the emotional experience of grief, institutional culture, and the value of rituals.

Conclusion(s): Pediatric residents face significant barriers to engaging in bereavement expression after patient loss. These results support the need and desire for structured bereavement opportunities within pediatric training programs, which may promote resilience, reflection, and emotional well-being for residents.