BACKGROUND The World Health Organization (WHO) recommends a multidimensional definition of palliative care for children as well as adults including relief of physical, psychological, so~i al , and spiritual suffering (1). In England, the distinction between palliative care and supportive care was recently debated (2). Supportive care was found to be a more general term, not related to a specific stage of a disease. Many elements of palliative care were also identified as part of supportive care, for example: relief of symptoms; and integration of psychological, social, and spiritual care. Palliative care seemed related to a more advanced stage of the illness and also to complicated symptoms, "complex end-of-life issues", and "unresolved symptoms and complex psychosocial issues for patients with advanced disease" (2). Nevertheless, there was significant overlap between the two definitions. Recent WHO recommendations call for the introduction of palliative care early in the course of a life-limiting illness (1). This recommendation is particularly challenging in children. In the United Kingdom, the Royal College of Paediatrics and Child Health (RCPCH) proposed four categories of pediatric illnesses that fulfill the definition of life-limiting disease and for which palliative care would be appropriate (3). These categories include diseases as diverse as cancer, muscular dystrophy or cystic fibrosis, cerebral palsy, and various syndromes such as San Filippo or Batten disease (3). In contrast to adults, the trajectories of these life-limiting diseases often evolve over many years. Their prognoses are less certain than for adults. The use of complex treatments such as organ transplantation, gene therapy, and mechanical ventilation increase the prognostic uncertainty, as Abstract I The objective of this study was to assess the concept of palliative care for a group of physicians in a tertiary care pediatric university hospital. Grounded theory methodology was used. Data included 12 semistructured interviews, field notes, research consent forms, research protocols, and articles published by the participants. Physicians involved in both research and clinical care of severely ill children were interviewed. Data analysis identified three principal themes. First, physicians limited their concept of palliative care to the relief of physical symptoms, equating palliative care with comfort care. Second, there was variation regarding the appropriate moment to introduce palliative care for children. Finally, many physicians were not comfortable using the term "palliative care". Although this study was conducted in one Canadian centre, the results raise questions that should be examined in other settings. A vague concept of palliative care may delay the provision of palliative care to children. .
