Validation of a Process for Shared Decision-Making in Pediatrics

Area of Science:

• Pediatric Healthcare
• Clinical Decision-Making
• Health Services Research

Background:

• Shared decision-making (SDM) is crucial in pediatrics, involving multiple stakeholders in healthcare choices.
• A proposed 4-step process guides SDM implementation, focusing on medical options, benefit-risk assessment, and patient preferences.
• Understanding the practical application and nuances of this SDM framework in pediatric settings is essential.

Purpose of the Study:

• To evaluate the validity and applicability of a 4-step SDM process in pediatric clinical encounters.
• To identify areas where the existing 4-step SDM model may need modification or further clarification.
• To explore clinician and parent perspectives on the implementation of SDM in pediatric care.

Main Methods:

• Videotaping of 30 pediatric inpatient and outpatient encounters across 7 clinical services.
• Post-encounter interviews with clinicians and parents utilizing video-stimulated recall.
• Direct content analysis of interview transcripts to assess the 4-step SDM process and identify emergent themes.

Main Results:

• Clinician and parent experiences confirmed the salience of all 4 steps of the proposed SDM process.
• Variations in the interpretation of each SDM step were observed among participants.
• The study highlighted the need for adaptability in applying the SDM process based on specific clinical and decisional contexts.

Conclusions:

• The 4-step SDM process is a relevant framework for pediatric decision-making.
• Further research is needed to provide clearer guidance on interpreting each step of the SDM process.
• Contextual factors significantly influence the successful implementation of SDM in pediatric care, suggesting a need for a flexible approach.