A LION IN THE HOUSE Module for Health Care Education: Pediatric End-of-Life Case Studies

Publication ID Published Volume
8362 February 14, 2012 8


Justin’s Story is part of Pediatric End-of-Life Case Studies, one of seven teaching modules drawn from the Emmy Award-winning documentary, A LION IN THE HOUSE (LION). LION portrays an unprecedented, intimate look at the realities of childhood cancer through the journeys of five families and their professional caregivers over the course of six years. Justin’s Story provides a forum for open-ended discussion and consideration of compassionate approaches for navigating pediatric end-of-life. It offers content that is unpredictable and not always best practice. Learners reflect on the complex impact of childhood cancer on Justin, his family and their professional caregivers. Justin’s Story is designed in consultation with top cancer organizations, leading professionals and medical educators to improve quality of teaching and learning, to enhance patient care, and fulfill competencies required by the Accreditation Council for Graduate Medical Education, among others. It is flexible—use for self-directed learning or with professionals in classroom or other settings, such as grand rounds. It embraces a humanistic perspective, with awareness of class, race and cultural difference. Justin’s Story is a case study made up of lively intimate movie clips, competencies and objectives, discussion questions, take-home points, recommended reading/resource lists and a PowerPoint presentation. The University of Cincinnati Evaluation Services Center contracted to complete the evaluation.

Community Media Productions contracted with the University of Cincinnati Evaluation Services Center to evaluate the LION Modules for Health Care Education. From November 2008 through October 2009, 2,168 participants were exposed to the modules, mostly through conference trainings and classrooms. Additionally, 1,100 pediatric nurses were trained in courses using the Lion modules through the End-of-Life Nursing Education Consortium Pediatric Palliative Care train-the-trainer sessions. 629 participants were trained in 13 different forums from 37 states, with 391 completing evaluation surveys. Of these, respondents to the Pediatric End-of-Life Module surveys (n=205) reported the following improvements: 65.4% were more likely to draw upon the strengths of the full health care team to communicate sensitively with the patient’s family at child end-of-life; 67.3% would better integrate a family’s religious and/or spiritual health care beliefs into discussions of treatment options; 95.6% were more sensitive to the balance between involving the family in decision-making and placing inappropriate burdens for these decisions on parents; and 92.7% would be more aware of their own personal reactions regarding death and dying. Respondents noted their top take-home points from the Pediatric End-of-Life Module: (1) Talk to patients about their wishes; (2) Communicate meaningfully with the family, bearing truth with more empathy; provide more comfort and support for families, especially parents; and, (3) Educate and train staff on pediatric palliative care issues; communicate and collaborate with peers/staff. Many survey respondents noted the following challenges they would likely meet: (1) Better use of the interdisciplinary team, especially when treatments are futile; (2) Current culture within medicine and within the institution; (3) Difficulty in dealing with families seeking for answers but no remedy; family not ready for end-of-life.

Editor’s Note
This publication includes large downloadable files. If you experience difficulty downloading these files, please contact mededportal@aamc.org to receive a free DVD version via mail.


Reichert J, Parmelee D, Bognar S, Durgans K, Godoy M. A LION IN THE HOUSE module for health care education: pediatric end-of-life case studies. MedEdPORTAL Publications. 2012;8:8362. http://doi.org/10.15766/mep_2374-8265.8362

Educational Objectives

  1. To develop strategies for the honest disclosure of prognosis, treatment options and goals of care, without taking away hope.
  2. To recommend ways to incorporate palliative care interventions concurrent with disease-directed treatments early in the treatment process.
  3. To articulate an approach for involving the patient and family in decision-making without placing inappropriate burdens in these decisions on them.


  • A Lion in the House, Childhood Cancer, Death, Truth Disclosure

Prior Scholarly Dissemination


Citations to Resource:

  1. Abrash, B: A Lion in the House: A Content-Centered Outreach Strategy for Public Broadcasting. American University Center for Social Media; November 2007.
  2. American Society of Clinical Oncology: Pediatric Cancer Documentary Highlights Challenging Aspects of Cancer Care. ASCO News and Forum; October 2006.
  3. Burki, T: Lion-Hearts. The Lancet Oncology; 2006 June 7(6): 465-466. http://dx.doi.org/10.1016/s1470-2045(06)70722-7
  4. Dickens, DS: Building Competence in Pediatric End-of-Life Care. Journal of Palliative Medicine; 2009 July 12(7): 617-622. http://dx.doi.org/10.1089/jpm.2009.0032
  5. Independent Television Service: A Lion in the House Community Engagement Campaign Report: Executive Summary. Independent Lens; June 2007. Available from: archive.itvs.org/outreach/lioninthehouse/resources/lion_summary.pdf.
  6. National Cancer Institute Center to Reduce Health Disparities: NCI Examines How to Partner With PBS to Promote Video on Childhood Cancer. Equal Access; 2005 2(1): p.10.

Presentations from Resource:

  1. Arceci R: Learning End-of-Life Care: The Media Can Help With The Message. American Society of Clinical Oncology Annual Meeting, Chicago, Illinois; June 2007.
  2. Bognar S, Reichert J: The Story of Tim Woods. The 9th Biennial Symposium on Minorities, The Medically Underserved & Cancer, Washington, DC; March 2004.
  3. Durgans K: Pediatric End-of-Life Case Studies. End-of-Life Nursing Education Consortium-Pediatric Palliative Care Train-the-Trainer Program, Sacramento, California; February 2009.
  4. Godoy M, Reichert J: Cancer Stories: The Impact of Narrative on a Modern Malady. Indiana University-Purdue University at Indianapolis—A Medical Humanities Symposium, Indianapolis, Indiana; November 2008.
  5. Parmelee D, Reichert J: A Lion in the House: Strategizing the Use of Intimate Real-Life Case Studies in Pediatric End-of-Life in Medical Education. Association of American Medical Colleges Annual Meeting, San Antonio, Texas; November 2008.

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