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Validation of a Process for Shared Decision-Making in Pediatrics.

Douglas J Opel1, Holly Hoa Vo2, Nicolas Dundas3

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The 4-step shared decision-making (SDM) process in pediatrics is relevant for clinicians and parents. However, its implementation requires flexibility and clear guidance on interpreting each step within specific contexts.

Keywords:
decision-makingpediatricsshared

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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.