To the Editor:

Crnjak and colleagues offer a timely simulation-based approach to preparing child life specialists for high-stakes psychosocial care at the end of life. We were particularly interested in the scenarios that incorporate memory-making, sibling engagement, and family dynamics. Their work demonstrates the value of practicing these infrequent and emotionally demanding encounters before clinicians face them with grieving families (Crnjak et al. Reference Crnjak, Kerns and Stevens2026). We suggest an additional educational objective: learners should be taught not only how to facilitate memory-making, but how to decide whether, when, and how it should be offered.

The educational endpoint should not be successful production of a handprint, photograph, recording, or memory box. Rather, memory-making is best understood as a relational palliative-care competency. Learners should recognize family cues and readiness, ask permission before introducing options, explain choices without implying obligation, explore what is meaningful to the child and family, and adapt the approach to cultural, spiritual, developmental, and family preferences. Equally important, learners should accept hesitation or refusal without persuasion. A recent systematic review similarly emphasized personalization, cultural sensitivity, flexibility, and trained facilitation as central to effective pediatric memory-making interventions (Safarifard et al. Reference Safarifard, Kiernan and Corcoran2025).

Simulation provides an ideal environment for practicing these behaviors. In addition to assessing whether the learner can introduce and facilitate an activity, faculty can assess whether the learner asks permission, follows family cues, communicates uncertainty, involves siblings in developmentally appropriate ways, and collaborates with nursing, child life, palliative care, chaplaincy, and social work when needed. Scenarios should also include families that decline a keepsake, change their minds, request a culturally meaningful ritual, or simply prefer time together. In such cases, the most competent response may be to step back rather than complete an activity.

Our recently described LEGACY-PICU framework offers a bedside scaffold for this approach, emphasizing listening, gentle explanation, choice, cultural and spiritual attention, safe creation of keepsakes, and space for privacy and ritual (Torrez et al. Reference Torrez, Ursua and Phillips2026). Its broader educational lesson is that memory-making should remain an invitation rather than a task.

Crnjak et al. have created an important foundation for simulation-based end-of-life education. Extending that model from procedural facilitation to relational judgment could help preserve the central outcome that matters most: family agency. A successful simulation need not end with a keepsake; sometimes it should end with a family feeling heard, respected, and free to choose.