Abstract
Objective
We sought to confirm, refute, or modify a 4-step process for implementing shared decision-making
(SDM) in pediatrics that involves determining 1) if the decision includes >1 medically
reasonable option; 2) if one option has a favorable medical benefit-burden ratio compared
to other options; and 3) parents' preferences regarding the options; then 4) calibrating
the SDM approach based on other relevant decision characteristics.
Methods
We videotaped a purposive sample of pediatric inpatient and outpatient encounters
at a single US children's hospital. Clinicians from 7 clinical services (craniofacial,
neonatology, oncology, pulmonary, pediatric intensive care, hospital medicine, and
sports medicine) were eligible. English-speaking parents of children who participated
in inpatient family care conferences or outpatient problem-oriented encounters with
participating clinicians were eligible. We conducted individual post-encounter interviews
with clinician and parent participants utilizing video-stimulated recall to facilitate
reflection of decision-making that occurred during the encounter. We utilized direct
content analysis with open coding of interview transcripts to determine the salience
of the 4-step SDM process and identify themes that confirmed, refuted, or modified
this process.
Results
We videotaped 30 encounters and conducted 53 interviews. We found that clinicians'
and parents' experiences of decision-making confirmed each SDM step. However, there
was variation in the interpretation of each step and a need for flexibility in implementing
the process depending on specific decisional contexts.
Conclusions
The 4-step SDM process for pediatrics appears to be salient and may benefit from further
guidance about the interpretation of each step and contextual factors that support
a modified approach.
Keywords
To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to Academic PediatricsAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- Prime Time for Shared Decision Making.JAMA. 2017; 317: 1309-1310
- Is Shared Decision-making the Right Approach for Febrile Infants?.Pediatrics. 2017; 140
- A Push for Progress With Shared Decision-making in Pediatrics.Pediatrics. 2017; 139
- Where is the evidence? A systematic review of shared decision making and patient outcomes.Medical decision making: an international journal of the Society for Medical Decision Making. 2015; 35: 114-131
- Shared decision making: a model for clinical practice.Journal of general internal medicine. 2012; 27: 1361-1367
- Shared decision-making in the medical encounter: what does it mean? (or it takes at least two to tango).Social science & medicine (1982). 1997; 44: 681-692
- A shared treatment decision-making approach between patients with chronic conditions and their clinicians: the case of diabetes.Health expectations: an international journal of public participation in health care and health policy. 2006; 9: 25-36
- Shared decision making in medicine: the influence of situational treatment factors.Patient education and counseling. 2011; 82: 240-246
- Shared medical decision making. A new tool for preventive medicine.American journal of preventive medicine. 2004; 26: 81-83
- Patient-centered care and preference-sensitive decision making.JAMA. 2009; 302: 1805-1806
- Interventions for promoting participation in shared decision-making for children and adolescents with cystic fibrosis.Cochrane Database Syst Rev. 2019; 5CD012578
- Gaps in the Implementation of Shared Decision-making: Illustrative Cases.Pediatrics. 2019; 143
- The promise of shared decision-making in paediatrics.Acta paediatrica. 2010; 99: 1464-1466
- Council On Children With D. Shared Decision-Making and Children With Disabilities: Pathways to Consensus.Pediatrics. 2017; 139
- Shared Decision Making in Pediatrics: A Systematic Review and Meta-analysis.Acad Pediatr. 2015; 15: 573-583
- Shared Decision-Making with Parents of Acutely Ill Children: A Narrative Review.Acad Pediatr. 2018; 18: 3-7
- What instruments should we use to assess paediatric decision-making interventions? A narrative review.J Child Health Care. 2020; 24: 458-472
- Pediatric Caregiver Version of the Shared Decision Making Process Scale: Validity and Reliability for ADHD Treatment Decisions.Acad Pediatr. 2022;
- A 4-Step Framework for Shared Decision-making in Pediatrics.Pediatrics. 2018; 142: S149-S156
- Patient-doctor decision-making about treatment within the consultation–a critical analysis of models.Social science & medicine. 2006; 62: 116-124
- A new model of medical decisions: exploring the limits of shared decision making.Med Decis Making. 2003; 23: 275-280
- Shared decision making, paternalism and patient choice.Health Care Anal. 2010; 18: 60-84
- Shared decision-making in primary care: tailoring the Charles et al. model to fit the context of general practice.Patient education and counseling. 2006; 62: 205-211
- The shared decision-making continuum.Jama. 2010; 304: 903-904
- When is a shared decision not (quite) a shared decision? Negotiating preferences in a general practice encounter.Social science & medicine (1982). 1999; 49: 437-447
- Management and the Worker.Harvard University Press, Cambridge, MA1939
- Family Conferences in the Neonatal ICU: Observation of Communication Dynamics and Contributions.Pediatr Crit Care Med. 2016; 17: 223-230
- The Pediatric Inpatient Family Care Conference: a proposed structure toward shared decision-making.Hosp Pediatr. 2014; 4: 305-310
- Getting under the skin of the primary care consultation using video stimulated recall: a systematic review.BMC Med Res Methodol. 2014; 14: 101
- Video elicitation interviews: a qualitative research method for investigating physician-patient interactions.Ann Fam Med. 2012; 10: 118-125
- Making decisions about chronic disease treatment: a comparison of parents and their adolescent children.Health Expect. 2016; 19: 716-726
- What is known about parents' treatment decisions? A narrative review of pediatric decision making.Medical decision making: an international journal of the Society for Medical Decision Making. 2012; 32: 246-258
- A Descriptive Study of Decision-Making Conversations during Pediatric Intensive Care Unit Family Conferences.J Palliat Med. 2018; 21: 1290-1299
- Qualitative Content Analysis.Forum: Qualitative Social Research. 2000; 1
- Key components of shared decision making models: a systematic review.BMJ Open. 2019; 9e031763
- An integrative model of shared decision making in medical encounters.Patient education and counseling. 2006; 60: 301-312
- From text to codings: intercoder reliability assessment in qualitative content analysis.Nursing research. 2008; 57: 113-117
- Research methods in anthropology: qualitative and quantitative methods.3rd ed. AltaMira Press, Walnut Creek, CA2002
- Pediatric Shared Decision-Making for Simple and Complex Decisions: Findings From a Delphi Panel.Pediatrics. 2022; 150
- Beyond information: exploring patients' preferences.JAMA. 2009; 302: 195-197
- Development and Evaluation of the Shared Decision Making Process Scale: A Short Patient-Reported Measure.Medical decision making: an international journal of the Society for Medical Decision Making. 2021; 41: 108-119
- Committee on Genetics, and, the American College of Medical Genetics, and Genomics Social, Ethical, and Legal Issues Committee. Ethical and policy issues in genetic testing and screening of children.Pediatrics. 2013; 131: 620-622
- Parental refusals of medical treatment: the harm principle as threshold for state intervention.Theoretical medicine and bioethics. 2004; 25: 243-264
- Audio-visual recording of patient-GP consultations for research purposes: a literature review on recruiting rates and strategies.Patient education and counseling. 2008; 71: 157-168
Article info
Publication history
Accepted:
January 16,
2023
Received:
October 14,
2022
Publication stage
In Press Journal Pre-ProofFootnotes
Funding: This study was supported by the Agency for Healthcare Research and Quality (AHRQ; grant number R03HS26994-01A1). AHRQ had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; or preparation, review, or approval of the manuscript.
Conflict of Interest Disclosures: There are no conflicts of interest, whether financial or other, expressed by all authors.
Identification
Copyright
© 2023 Published by Elsevier Inc. on behalf of Academic Pediatric Association
