Characterizing How Pediatric Clinicians Create Choice Awareness When Performing Shared Decision-Making

To characterize how clinicians create choice awareness when performing shared decision-making (SDM).

We conducted a secondary analysis of a cross-sectional observational study designed to characterize the decision-making processes of parents and clinicians across a range of medical decisions in different pediatric settings. For the observational study, clinicians were recruited from 6 pediatric specialties (craniofacial, hematology and oncology, hospital medicine, neonatology, pulmonary, and sports medicine) at a single US children's hospital. We videotaped inpatient care conferences and outpatient problem-oriented encounters. We then conducted individual postencounter interviews with parents and clinicians about the decisions they made in those encounters. For the secondary analysis, we identified all videotaped encounters that included a decision in which the clinician stated in their postencounter interview that there were multiple options and they were performing SDM. With this sample, we used conversation analysis to characterize how clinicians created choice awareness.

There were 34 shared decisions from 21 videotaped encounters included in analysis. We found 2 overarching approaches clinicians used to create choice awareness: 1) presenting 1 option and recommending it as the next step in management without making other options explicit, though allowing those options to emerge as needed (single-option approach), or 2) making it explicit up-front that there were multiple options (multiple-options approach). Though both approaches could facilitate SDM, the multiple-options approach does so most unambiguously.

There is variation in how pediatric clinicians create choice awareness, an essential element of SDM. Further standardization of communicating choice awareness can improve implementation of SDM.