I would be very interested to see what you find in the study described in question 2. I think the different variables you bring up are important ones, and agree that it would be interesting to better understand the perceptions of the families and the providers after such difficult conversations. I would also be interested if you could measure whether or not these conversations are being requested by family or initiated by the providers, and see if/how race may play a role. If families/parents of different races/ethnicities or different SES groups feel more comfortable advocating for their children, they may be requesting more family meetings resulting in better communication with the providers. Alternatively, if families/parents from groups with poorer communication or language discordance, healthcare mistrust, full-time jobs with inability to be at the hospital etc, are not requesting meetings, providers (who are understandably busy), may not initiate these types of meetings as often or until a negative event or outcome has occurred. This is simply based on my experience in adult medicine, but perhaps it is applicable to pediatrics.