{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,22]],"date-time":"2026-06-22T22:54:44Z","timestamp":1782168884880,"version":"3.54.5"},"reference-count":49,"publisher":"BMJ","issue":"7","license":[{"start":{"date-parts":[[2025,7,30]],"date-time":"2025-07-30T00:00:00Z","timestamp":1753833600000},"content-version":"unspecified","delay-in-days":29,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"funder":[{"DOI":"10.13039\/100012285","name":"BC Children\u2019s Hospital Research Institute","doi-asserted-by":"crossref","award":["Healthy Starts Catalyst Grant"],"award-info":[{"award-number":["Healthy Starts Catalyst Grant"]}],"id":[{"id":"10.13039\/100012285","id-type":"DOI","asserted-by":"crossref"}]}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Open"],"accepted":{"date-parts":[[2025,7,1]]},"published-print":{"date-parts":[[2025,7]]},"abstract":"<jats:sec>\n                    <jats:title>Objectives<\/jats:title>\n                    <jats:p>To characterise neonatal intensive care unit (NICU) parents\u2019 grieving process across time and to identify their perspectives on the healthcare providers\u2019 actions that acted as facilitators or barriers to the grieving process in the short (3\u20139 months) and longer term (18\u201324 months).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Design<\/jats:title>\n                    <jats:p>Longitudinal mixed-methods study combining standardised grief and care satisfaction scales with qualitative data collected through semistructured interviews. The qualitative component was guided by an interpretive description approach, which is well-suited for generating clinically relevant insights into complex human experiences such as parental grief. Triangulating quantitative and qualitative data enhanced insight into how parental grief and perceptions of care evolved between 3\u20139 months and 18\u201324 months post loss.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Setting<\/jats:title>\n                    <jats:p>Tertiary-level NICU hospital in British Columbia, Canada.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Participants<\/jats:title>\n                    <jats:p>13 parents participated in the study, including 10 mothers and three fathers. Among them were two couples who participated as individuals. Their median age was 35 years (IQR: 32\u201338).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Primary and secondary outcome measures<\/jats:title>\n                    <jats:p>Quantitative data obtained through the application of the Perinatal Grief Scale (PGS) and care satisfaction scale and qualitative data collected through semistructured interviews. Data were collected at two points (3\u20139 months and 18\u201324 months post loss) to track parents\u2019 grief over time.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>The PGS scores indicated active grieving without complicated grief, while the Care Satisfaction Scale reflected high overall satisfaction with care. Thematic analysis identified two primary grieving stages: the initial traumatic event during NICU hospitalisation and the complex adjustment to life post loss. Key factors influencing parents\u2019 coping mechanisms included respecting the infant\u2019s dignity, enhancing communication and decision-making, preserving the bond between parents and the NICU team, nurturing enduring connections with the infant and aiding in finding meaning from the experience.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>The study outlined the stages parents experience during and after infant loss, offering practical steps for NICU professionals to aid families in their healing process.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1136\/bmjopen-2025-100264","type":"journal-article","created":{"date-parts":[[2025,7,30]],"date-time":"2025-07-30T11:20:34Z","timestamp":1753874434000},"page":"e100264","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":1,"title":["Parental grief following infant death in the NICU: a longitudinal mixed-methods exploration of parental experiences and influencing factors"],"prefix":"10.1136","volume":"15","author":[{"ORCID":"https:\/\/orcid.org\/0009-0003-9527-0176","authenticated-orcid":false,"given":"Esther","family":"Alonso-Prieto","sequence":"first","affiliation":[{"name":"Department of Pediatrics, BC Women\u2019s Hospital and Health Centre, Vancouver, British Columbia, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rachelle","family":"Chung","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, BC Children\u2019s Hospital Research Institute, Vancouver, British Columbia, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kelly","family":"Allison","sequence":"additional","affiliation":[{"name":"The University of British Columbia, Vancouver, British Columbia, 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Resilient vulnerabilities: bereaved persons discuss their experience of participating in thanatology research. Qualit Ethics Pract 2016;85\u201396."},{"key":"2025121422444036000_15.7.e100264.47","doi-asserted-by":"crossref","unstructured":"Casarett D . Ethical issues in palliative care research. In: Oxford textbook of palliative medicine. 2010: 416\u201321.","DOI":"10.1093\/med\/9780198570295.003.0042"},{"key":"2025121422444036000_15.7.e100264.48","doi-asserted-by":"publisher","DOI":"10.1542\/peds.2007-1005"},{"key":"2025121422444036000_15.7.e100264.49","unstructured":"Albersheim SG . Matters of life and death in the neonatal intensive care unit: decision-making for the non-yet-competent. 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