Interventions to Promote Pediatric Shared Decision-Making and Child Engagement in Primary Care: A Systematic Review

To systematically describe outcomes of child-, clinician-, and clinic-facing interventions to improve shared decision-making (SDM) and child engagement in primary care.

A trained health services librarian searched 5 databases. Included studies collected primary data (observational or randomized control trials), assessed child-, clinician-, or clinic-facing interventions aimed at improving SDM and/or engagement-related outcomes for children ages 7 to 18, focused on conditions commonly treated in primary care, and were published between January 2014 and April 2024. Two authors screened studies, extracted data, and assessed risk of bias and strength of evidence.

Sixteen studies met inclusion criteria. One study had a low level of bias and 15 had moderate levels. Interventions included single- or multisession trainings, coaching, communication guides, and integration into clinical flow. Eight were clinician-facing, 3 were clinician- and child-facing, 2 were child-facing, and 3 focused on clinic-level change. Nine included child-reported outcomes. Heterogeneous outcome measures precluded meta-analysis. However, interventions generally improved knowledge and information-sharing, with mixed or nonsignificant impact on patient-centered communication, participatory behaviors, self-efficacy, and validated SDM measures. Some negative outcomes were noted, such as clinician apprehension and decreased encounter efficiency. Based on the studies' outcomes, we generated an inductive conceptual model for factors that impact pediatric SDM and engagement in care.

Interventions to promote SDM and engagement in pediatric primary care showed mixed but mostly positive results. Interventions were often not designed to interface with children directly. More systematic measurement of outcomes is needed to compare across studies. Future interventions should consider additional youth involvement.