Table 1.

Elements of Instrument Packet Being Pilot Tested

Section	Description	Items	Source
About Your Child	Child-related demographics	7 items Gender, date of birth, date of death, cause of death, length of stay in PICU, # hospital admissions, # PICU admissions	Investigator developed
Bereaved Parent Needs Assessment–PICU	Items about specific needs that parents had around the time of their child’s death in the PICU	68 items Two 5-point Likert scales—Importance/Fulfillment 2 open-ended items	Investigator developed — NEW TOOL
Inventory of Complicated Grief	Series of first-person items about feelings regarding the child who died	19 items 5-point Likert scale rating frequency of feeling	Prigerson et al. (1995)
WHO-QOLBREF	Item stems regarding overall quality of life and health status including physical and mental health	26 items 5-point Likert scale	WHOQOL Group (1998)
WHO-QOL 100 selected items	Items regarding personal beliefs and meaning	4 items 5-point Likert scale	WHOQOL Group (1998)
About Yourself	Personal parent demographics	7 items Gender, date of birth, relation to child, race, ethnicity, education, other children died (Y/N), # living children, marital status	Investigator developed
Survey Experience	Feedback on survey experience	3 items Ease of answering questions, amount of time to complete, additional comments	Investigator developed