Validation of a Process for Shared Decision-Making in Pediatrics

被引:9
作者
Opel, Douglas J. [1 ,2 ,3 ,20 ,21 ,22 ]
Vo, Holly Hoa [3 ,4 ,5 ]
Dundas, Nicolas [3 ]
Spielvogle, Heather [3 ]
Mercer, Amanda [3 ]
Wilfond, Benjamin S. [3 ,4 ,5 ]
Clark, Jonna [3 ,6 ,7 ]
Heike, Carrie L. [8 ,9 ]
Weiss, Elliott M. [5 ,10 ,11 ]
Bryan, Mersine A. [9 ,12 ]
Shah, Seema K. [13 ,14 ]
Mccarty, Carolyn A. [15 ,16 ]
Robinson, Jeffrey D. [17 ]
Blumenthal-Barby, Jennifer [18 ]
Tilburt, Jon [19 ]
机构
[1] Univ Washington, Div Bioeth & Palliat, Sch Med, Seattle, WA USA
[2] Univ Washington, Dept Pediat, Div Gen Pediat, Sch Med, Seattle, WA USA
[3] Seattle Childrens Res Inst, Treuman Katz Ctr Pediat Bioeth, Seattle, WA USA
[4] Univ Washington, Div Pulm & Sleep Med, Sch Med, Seattle, WA USA
[5] Univ Washington, Dept Pediat, Div Bioeth & Palliat Care, Sch Med, Seattle, WA USA
[6] Univ Washington, Div Crit Care Med, Sch Med, Seattle, WA USA
[7] Univ Washington, Dept Pediat, Div Bioeth & Palliat Care, Sch Med, Seattle, WA USA
[8] Univ Washington, Dept Pediat, Div Craniofacial Med, Sch Med, Seattle, WA USA
[9] Seattle Childrens Res Inst, Ctr Clin & Translat Res, Seattle, WA USA
[10] Univ Washington, Div Neonatol, Sch Med, Seattle, WA USA
[11] Treuman Katz Ctr Pediat Bioeth, Seattle, WA USA
[12] Univ Washington, Div Hosp Med, Dept Pediat, Sch Med, Seattle, WA USA
[13] Northwestern Univ, Dept Pediat, Feinberg Sch Med, Chicago, IL USA
[14] Lurie Childrens Hosp, Bioeth Program, Chicago, IL USA
[15] Univ Washington, Dept Pediat, Div Gen Pediat, Sch Med, Seattle, WA USA
[16] Seattle Childrens Res Inst, Ctr Child Hlth Behav & Dev, Seattle, WA USA
[17] Portland State Univ, Dept Commun, Portland, OR 97214 USA
[18] Baylor Coll Med, Ctr Med Ethics & Hlth Policy, Houston, TX USA
[19] Mayo Clin, Dept Internal Med, Div Gen Internal Med, Scottsdale, AZ USA
[20] Univ Washington, Sch Med, Div Bioeth & Palliat, 1900 Ninth Ave,M S JMB-6, Seattle, WA 98101 USA
[21] Univ Washington, Dept Pediat, Div Gen Pediat, Sch Med, 1900 Ninth Ave,M S JMB-6, Seattle, WA 98101 USA
[22] Seattle Childrens Res Inst, Treuman Katz Ctr Pediat Bioeth, 1900 Ninth Ave,M S JMB-6, Seattle, WA 98101 USA
基金
美国医疗保健研究与质量局;
关键词
decision-making; pediatrics; shared; MODEL; PARENTS; CARE;
D O I
10.1016/j.acap.2023.01.007
中图分类号
R72 [儿科学];
学科分类号
100202 ;
摘要
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.
引用
收藏
页码:1588 / 1597
页数:10
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