Validation of a Process for Shared Decision-Making in Pediatrics

• Published in: Academic pediatrics 2023-11, Vol.23 (8), p.1588-1597
• Main Authors: Opel, Douglas J., Vo, Holly Hoa, Dundas, Nicolas, Spielvogle, Heather, Mercer, Amanda, Wilfond, Benjamin S., Clark, Jonna, Heike, Carrie L., Weiss, Elliott M., Bryan, Mersine A., Shah, Seema K., McCarty, Carolyn A., Robinson, Jeffrey D., Blumenthal-Barby, Jennifer, Tilburt, Jon
• Format: Article
• Language: English
• Subjects: Child; Decision Making; Decision Making, Shared; Delivery of Health Care; Humans; Neonatology; Parents; pediatrics; shared
• ISSN: 1876-2859; 1876-2867; 1876-2867
• DOI: 10.1016/j.acap.2023.01.007

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. 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 postencounter 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. 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. 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.