The Association Between Shared Decision-Making and Child Health in the General Pediatric Population

Shared decision-making (SDM) is a decision-making approach that aims to enhance collaboration between patients and providers. SDM is associated with improved health outcomes and decreased healthcare expenditure among children with special health care needs. However, much remains unknown about the role of SDM in the broader general pediatric population. We sought to describe associations between SDM and child health and healthcare utilization in a national pediatric sample.

Using data from the 2019-2021 National Survey of Children's Health, we examined the association between SDM and forgone health care, missed school days due to illness or injury, and emergency department (ED) visits. Bivariate and multivariable logistic regression analyses were performed and adjusted for sociodemographic variables.

The study sample included 31,791 children who needed medical decisions made in the prior 12 months (mean age 8.7 years, 42.3% with special health care needs). Most (85%) experienced SDM. In adjusted analysis, SDM was associated with significantly lower odds of children forgoing needed health care (adjusted odds ratio [aOR] = 0.22, 95% confidence interval [CI] 0.17-0.27), and lower odds of > 4 missed school days (aOR = 0.80, 95% CI 0.66-0.95). Experiencing SDM was not associated with ED visits.

SDM may confer benefits for all children in a general pediatric population. Experiencing SDM was associated with less forgone health care and fewer missed school days due to illness or injury. Future work should explore approaches to SDM that consider the needs and preferences of families across the spectrum of pediatric care.