Collaboration Amidst Contested Definitions: A Qualitative Ethnography of Shared Decision-Making in a Paediatric...

To explore how children, caregivers and healthcare providers experience shared decision-making in real time within an interdisciplinary paediatric feeding clinic in multicultural Singapore.

A qualitative ethnographic approach was used.

Data collection involved one-time participant observations of interdisciplinary feeding clinic consultations, observations of healthcare providers-only debrief and follow-up interviews with caregivers. Data were collected from July 2024 to November 2024. Participants included caregivers, healthcare providers and otherwise well children presenting with feeding difficulties. Fieldnotes, including observational matrices, reflexive journals and interview transcripts, were analysed thematically using Braun and Clarke's six-step process for thematic analysis.

Twenty observations and 11 interviews were conducted. Four themes were identified: (1) Centring the child: building trust and respect; (2) Tensions and teamwork: negotiating expertise and expectations; (3) Feeding across cultures; and (4) Parenting under pressure: the social context of feeding choices.

In an interdisciplinary feeding clinic, shared decision-making extends beyond the clinical encounter, reflecting relational, cultural and structural realities. The feeding clinic modelled effective shared decision-making through child-centred care practices, balancing biomedical expertise with lived experiences, actively engaging caregivers and codesigning culturally responsive and sustainable feeding strategies with the family. However, divergent perceptions of what problematic feeding entails, caregivers' hesitancy in taking on an active role in consultations, and the external pressures caregivers contended with constrained this process. These findings highlight the need for inclusive, culturally responsive care models and more caregiver support interventions that acknowledge the full complexity of feeding care.

Nurses, with their central role in relational and communicative care, are uniquely positioned to bridge tensions between medical paternalism and collaborative, family-centred approaches. By facilitating trust, clarifying goals and supporting caregiver participation in feeding decisions, they play a critical role in advancing child health outcomes while strengthening caregiver agency within multicultural healthcare systems.

This study revealed how cultural, familial and systemic pressures shape caregiving practices, often constraining caregiver participation and shared decision-making in clinical encounters. Shared decision making in an interdisciplinary feeding clinic comprised of child-centred care practices, balancing biomedical expertise with lived experiences, actively engaging caregivers and codesigning culturally responsive and sustainable feeding strategies with the family. This study expounds on the potentially critical role nurses could play within the multidisciplinary team to negotiate expectations, foster caregiver agency and contribute to culturally responsive, family-centred feeding care.

The reporting of this study is guided by the Standards for Reporting Qualitative Research (SRQR).

This study did not include patient or public involvement in its design, conduct or reporting.