Patient, Family and Health Professional Perspectives on Shared Decision-Making for In-Person Versus Virtual Pediatric...

Pediatric chronic pain disproportionately affects equity-denied groups (e.g., racialized, with disabilities). While virtual care may be more accessible for some, it can underserve those impacted by social disparities (e.g., low technology access). Moreover, youth and their families are not always included in treatment decisions for chronic pain. Understanding how virtual delivery impacts individuals of diverse sociocultural contexts is needed to deliver quality care. As part of a needs assessment for decision aid development, perspectives of patients/families and health professionals were gathered regarding decisional needs for in-person versus virtual pediatric chronic pain care delivery. Fifteen patients/families (8 youth with chronic pain, 7 caregivers) and fifteen multidisciplinary health professionals completed an online survey and semi-structured interview on virtual versus in-person care experiences. Purposive sampling was conducted for patients/families who are racialized or have complex medical needs and/or neurodevelopmental disabilities. Data were analyzed within each group using reflexive thematic analysis. Themes created from patients/families highlighted the need to consider: "individual patient/family needs and preferences"; "patients' struggles in navigating healthcare"; and "the importance of partnership in a paternalistic system". Themes generated from health professionals underscored the importance of: "individual clinical needs"; "patient engagement and adherence to care"; "clinician characteristics and values"; and "the decision-making context". Findings reflect differing perspectives between patients, families and health professionals on decision-making for in-person versus virtual delivery of pediatric chronic pain care. This study highlights the importance of increasing knowledge on virtual care and facilitating shared decision-making conversations to support more equitable, person-centred decisions around care delivery. PERSPECTIVE: This article presents the perspectives of patients, families and health professionals on decisional needs for in-person versus virtual pediatric chronic pain care. Though these varied due to individual, relational, and systems-level factors, results emphasized the need for more evidence to support decisions. Informed and collaborative decision-making can promote patient-centred care.