Validation of a Process for Shared Decision-Making in Pediatrics

doi:10.1016/j.acap.2023.01.007

. 2023 Nov-Dec;23(8):1588-1597.

doi: 10.1016/j.acap.2023.01.007. Epub 2023 Jan 20.

Validation of a Process for Shared Decision-Making in Pediatrics

Affiliations

¹ Division of Bioethics and Palliative and Division of General Pediatrics, Department of Pediatrics, University of Washington School of Medicine and Treuman Katz Center for Pediatric Bioethics, Seattle Children's Research Institute (DJ Opel), Seattle, Wash. Electronic address: douglas.opel@seattlechildrens.org.
² Division of Pulmonary and Sleep Medicine and Division of Bioethics and Palliative Care, Department of Pediatrics, University of Washington School of Medicine and Treuman Katz Center for Pediatric Bioethics, Seattle Children's Research Institute (HH Vo and BS Wilfond), Seattle, Wash.
³ Treuman Katz Center for Pediatric Bioethics, Seattle Children's Research Institute (N Dundas, H Spielvogle, and A Mercer), Seattle, Wash.
⁴ Division of Critical Care Medicine and Division of Bioethics and Palliative Care, Department of Pediatrics, University of Washington School of Medicine and Treuman Katz Center for Pediatric Bioethics, Seattle Children's Research Institute (J Clark), Seattle, Wash.
⁵ Division of Craniofacial Medicine, Department of Pediatrics, University of Washington School of Medicine and Center for Clinical and Translational Research, Seattle Children's Research Institute (CL Heike), Seattle, Wash.
⁶ Division of Neonatology and Division of Bioethics and Palliative Care, Department of Pediatrics, University of Washington School of Medicine and Treuman Katz Center for Pediatric Bioethics (EM Weiss), Seattle, Wash.
⁷ Division of Hospital Medicine, Department of Pediatrics, University of Washington School of Medicine and Center for Clinical and Translational Research, Seattle Children's Research Institute (MA Bryan), Seattle, Wash.
⁸ Department of Pediatrics, Northwestern University Feinberg School of Medicine; Bioethics Program, Lurie Children's Hospital (SK Shah), Chicago, Ill.
⁹ Division of General Pediatrics, Department of Pediatrics, University of Washington School of Medicine and Center for Child Health, Behavior, and Development, Seattle Children's Research Institute (CA McCarty), Seattle, Wash.
¹⁰ Department of Communication, Portland State University (JD Robinson), Portland, Ore.
¹¹ Center for Medical Ethics and Health Policy, Baylor College of Medicine (J Blumenthal-Barby), Houston, Tex.
¹² Division of General Internal Medicine, Department of Internal Medicine, Mayo Clinic (J Tilburt), Scottsdale, Ariz.

PMID: 36682451
PMCID: PMC11542104
DOI: 10.1016/j.acap.2023.01.007

Validation of a Process for Shared Decision-Making in Pediatrics

Douglas J Opel et al. Acad Pediatr. 2023 Nov-Dec.

. 2023 Nov-Dec;23(8):1588-1597.

doi: 10.1016/j.acap.2023.01.007. Epub 2023 Jan 20.

Authors

Affiliations

¹ Division of Bioethics and Palliative and Division of General Pediatrics, Department of Pediatrics, University of Washington School of Medicine and Treuman Katz Center for Pediatric Bioethics, Seattle Children's Research Institute (DJ Opel), Seattle, Wash. Electronic address: douglas.opel@seattlechildrens.org.
² Division of Pulmonary and Sleep Medicine and Division of Bioethics and Palliative Care, Department of Pediatrics, University of Washington School of Medicine and Treuman Katz Center for Pediatric Bioethics, Seattle Children's Research Institute (HH Vo and BS Wilfond), Seattle, Wash.
³ Treuman Katz Center for Pediatric Bioethics, Seattle Children's Research Institute (N Dundas, H Spielvogle, and A Mercer), Seattle, Wash.
⁴ Division of Critical Care Medicine and Division of Bioethics and Palliative Care, Department of Pediatrics, University of Washington School of Medicine and Treuman Katz Center for Pediatric Bioethics, Seattle Children's Research Institute (J Clark), Seattle, Wash.
⁵ Division of Craniofacial Medicine, Department of Pediatrics, University of Washington School of Medicine and Center for Clinical and Translational Research, Seattle Children's Research Institute (CL Heike), Seattle, Wash.
⁶ Division of Neonatology and Division of Bioethics and Palliative Care, Department of Pediatrics, University of Washington School of Medicine and Treuman Katz Center for Pediatric Bioethics (EM Weiss), Seattle, Wash.
⁷ Division of Hospital Medicine, Department of Pediatrics, University of Washington School of Medicine and Center for Clinical and Translational Research, Seattle Children's Research Institute (MA Bryan), Seattle, Wash.
⁸ Department of Pediatrics, Northwestern University Feinberg School of Medicine; Bioethics Program, Lurie Children's Hospital (SK Shah), Chicago, Ill.
⁹ Division of General Pediatrics, Department of Pediatrics, University of Washington School of Medicine and Center for Child Health, Behavior, and Development, Seattle Children's Research Institute (CA McCarty), Seattle, Wash.
¹⁰ Department of Communication, Portland State University (JD Robinson), Portland, Ore.
¹¹ Center for Medical Ethics and Health Policy, Baylor College of Medicine (J Blumenthal-Barby), Houston, Tex.
¹² Division of General Internal Medicine, Department of Internal Medicine, Mayo Clinic (J Tilburt), Scottsdale, Ariz.

PMID: 36682451
PMCID: PMC11542104
DOI: 10.1016/j.acap.2023.01.007

Abstract

Objective: We sought to confirm, refute, or modify a 4-step process for implementing shared decision-making (SDM) in pediatrics that involves determining 1) if the decision includes >1 medically reasonable option; 2) if one option has a favorable medical benefit-burden ratio compared to other options; and 3) parents' preferences regarding the options; then 4) calibrating the SDM approach based on other relevant decision characteristics.

Methods: We videotaped a purposive sample of pediatric inpatient and outpatient encounters at a single US children's hospital. Clinicians from 7 clinical services (craniofacial, neonatology, oncology, pulmonary, pediatric intensive care, hospital medicine, and sports medicine) were eligible. English-speaking parents of children who participated in inpatient family care conferences or outpatient problem-oriented encounters with participating clinicians were eligible. We conducted individual postencounter interviews with clinician and parent participants utilizing video-stimulated recall to facilitate reflection of decision-making that occurred during the encounter. We utilized direct content analysis with open coding of interview transcripts to determine the salience of the 4-step SDM process and identify themes that confirmed, refuted, or modified this process.

Results: We videotaped 30 encounters and conducted 53 interviews. We found that clinicians' and parents' experiences of decision-making confirmed each SDM step. However, there was variation in the interpretation of each step and a need for flexibility in implementing the process depending on specific decisional contexts.

Conclusions: The 4-step SDM process for pediatrics appears to be salient and may benefit from further guidance about the interpretation of each step and contextual factors that support a modified approach.

Keywords: decision-making; pediatrics; shared.

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Conflict of interest statement

The authors have no conflicts of interest to disclose.

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References

1. Spatz ES, Krumholz HM, Moulton BW. Prime time for shared decision making. JAMA. 2017;317:1309–1310. - PubMed
1. Aronson PL, Fraenkel L. Is shared decision-making the right approach for febrile infants? Pediatrics. 2017;140: e20170225. - PMC - PubMed
1. Opel DJ. A push for progress with shared decision-making in pediatrics. Pediatrics. 2017;139: e20162526. - PubMed
1. Shay LA, Lafata JE. Where is the evidence? A systematic review of shared decision making and patient outcomes. Med Decis Making. 2015;35:114–131. - PMC - PubMed
1. Elwyn G, Frosch D, Thomson R, et al. Shared decision making: a model for clinical practice. J Gen Intern Med. 2012;27:1361–1367. - PMC - PubMed

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[1] Spatz ES, Krumholz HM, Moulton BW. Prime time for shared decision making. JAMA. 2017;317:1309–1310. - PubMed

[2] Spatz ES, Krumholz HM, Moulton BW. Prime time for shared decision making. JAMA. 2017;317:1309–1310. - PubMed

[3] Aronson PL, Fraenkel L. Is shared decision-making the right approach for febrile infants? Pediatrics. 2017;140: e20170225. - PMC - PubMed

[4] Aronson PL, Fraenkel L. Is shared decision-making the right approach for febrile infants? Pediatrics. 2017;140: e20170225. - PMC - PubMed

[5] Opel DJ. A push for progress with shared decision-making in pediatrics. Pediatrics. 2017;139: e20162526. - PubMed

[6] Opel DJ. A push for progress with shared decision-making in pediatrics. Pediatrics. 2017;139: e20162526. - PubMed

[7] Shay LA, Lafata JE. Where is the evidence? A systematic review of shared decision making and patient outcomes. Med Decis Making. 2015;35:114–131. - PMC - PubMed

[8] Shay LA, Lafata JE. Where is the evidence? A systematic review of shared decision making and patient outcomes. Med Decis Making. 2015;35:114–131. - PMC - PubMed

[9] Elwyn G, Frosch D, Thomson R, et al. Shared decision making: a model for clinical practice. J Gen Intern Med. 2012;27:1361–1367. - PMC - PubMed

[10] Elwyn G, Frosch D, Thomson R, et al. Shared decision making: a model for clinical practice. J Gen Intern Med. 2012;27:1361–1367. - PMC - PubMed

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Validation of a Process for Shared Decision-Making in Pediatrics

Affiliations

Validation of a Process for Shared Decision-Making in Pediatrics

Authors

Affiliations

Abstract

Conflict of interest statement

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MeSH terms

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