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- In discussions with children and their parents, investigate whether there are aspects of their religious or philosophical beliefs that should be taken into account in care, especially in decision-making about treatment options.
- Ask about the uniqueness and specialness of the child and the specific meaning-making of parents, especially with regard to their child's quality of life and his or her place in the family.
- Explore whether children and their parents would like to talk to someone about their beliefs and values (e.g., religious, spiritual or cultural). Refer to a spiritual counsellor for this purpose, if necessary.
- Take into account and enquire about what rituals are performed and what needs the children and parents may have, especially in the terminal phase.
- Be open to spiritual experiences that may play a role in children and families without being linked to religion or a philosophical framework. Ask what is meaningful, and important to them at this time.
- Be alert to the influence of culture and, if parents wish, include their family or other people in their network in communication around decision making, as they may otherwise exert an unseen influence on the decision-making process.
- Be open to the fact that parents have the right to "consciously not want to know’. Also provide space when parents want to know more.
- Be aware that certain terminology can create misunderstandings. For example, "We are going to discontinue treatment" suggests that treatment is available, but is being withheld from this child.
- Be aware that in many cultures the child's spiritual well-being takes precedence over the importance of hearing the truth and that for religious reasons it may be difficult for parents to agree to discontinue treatment.
- Keep in mind that if parents hold out hope for a good outcome until the end it does not mean that they have not heard or understood the bad news.
- Engage a spiritual counsellor when uncertain about the appropriate approach to people of a different culture or religion or for information about performing rituals.
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