A scoping review on adaptations incorporated into decision aids for children and adolescents (C&A) cohorts

Shared decision-making (SDM) is especially important for children and adolescents (C&A) as it promotes cooperation between patients, families, and healthcare professionals, enhances patient satisfaction and health outcomes. By enabling C&A to actively engage in their care, it ensures that their values and preferences taken into account. To enhance this collaborative process, decision aids (DA) serve as a valuable tool. It is crucial to note the need for tailoring these DAs to meet the unique demands of C&A during these SDM processes. However, data are scarce regarding the adaptations necessary for DAs geared towards C&A health-related decision-making. We aim to bridge this knowledge gap and provide insights into specific DA adaptations that can benefit the C&A population during their healthcare decision-making process.

The literature review was conducted systematically in PubMed and MEDLINE(Ovid) electronic databases. References of the identified studies were reviewed, along with hand-searches of relevant journals. English language publications that were eligible for inclusion were reviewed. Three aspects of adaptations were the focus of this review: namely (I) technical adaptation; (II) linguistic/numerical/visual adaptations and lastly; (III) content adaptation.

Ultimately, from an initial search of 37,422 articles, we retrieved and reviewed eighty full-text articles, and eight were included in this scoping review. Five were dyadic DAs and the rest triadic DAs. The DAs were an array of electronic-based, paper-booklet and model-based format. Four outcomes of technical adaptations were identified: (I) interactivity and ease of use, (II) simplified information presentation, (III) user category versions, and (IV) enhanced engagement. Linguistic/numerical/visual adaptations included two outcomes of: (I) health-literacy appropriateness, and (II) attractive non-textual presentation. Finally, under Content adaptation, two outcomes were identified: (I) disclosure of sensitive topics and (II) personalized content.

In summary, various forms of C&A adaptations were evident across all surveyed DAs. Most frequently encountered C&A adaptations were in the form of technical adaptations followed by linguistic, numerical, or visual modifications. Considerations of which types of adaptations to incorporate in a DA designed for C&A may give added value to the overall DA design, which in turn could assist the decision-making process. Further research to explore the performance of these C&A adapted DAs in achieving SDM is needed.