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Gaps in the Implementation of Shared Decision-making: Illustrative Cases
Elliott Mark Weiss1,2, Jonna D Clark3,2, Carrie L Heike2
1Treuman Katz Center for Pediatric Bioethics, Seattle Children's Research Institute, Seattle Children's Hospital, Seattle, Washington; emweiss@uw.edu.
Pediatrics
|March 3, 2019
Summary
Shared decision-making (SDM) in pediatrics requires refinement for effective clinical implementation. Key questions involve medical reasonableness, public health, adolescent autonomy, and parental burden.
Area of Science:
- Pediatric Healthcare
- Clinical Decision-Making
- Bioethics
Background:
- Shared decision-making (SDM) is crucial for aligning evidence-based care with patient values.
- Implementing SDM in pediatrics is complex due to parental involvement as surrogates.
- A provisional framework for pediatric SDM exists but needs refinement.
Observation:
- The provisional framework was applied to diverse pediatric cases across specialties.
- Several critical questions emerged regarding the application and scope of pediatric SDM.
- These questions highlight areas requiring further research and practical guidance.
Findings:
- Determining when SDM is required for medical decisions.
- Defining 'medically reasonable' options, especially with practice variability.
- Integrating adolescent autonomy and addressing parental decisional burden are key challenges.
Implications:
- Refining the pediatric SDM framework is essential for clinical practice.
- Further research is needed to address the identified complexities.
- Improved SDM implementation can enhance pediatric patient-centered care.
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