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Acad Pediatr. 2015 Nov-Dec;15(6):573-83. doi: 10.1016/j.acap.2015.03.011. Epub 2015 May 14.

Shared Decision Making in Pediatrics: A Systematic Review and Meta-analysis.

Author information

1
Pediatric and Adolescent Medicine Residency Program, Mayo School of Graduate Medical Education, Mayo Clinic, Rochester, Minn; Mayo Medical School, Mayo Clinic, Rochester, Minn; Knowledge and Evaluation Research Unit, Mayo Clinic, Rochester, Minn.
2
James M. Anderson Center for Health Systems Excellence, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio.
3
Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio.
4
Knowledge and Evaluation Research Unit, Mayo Clinic, Rochester, Minn; Unidad de Conocimiento y Evidencia, Universidad Peruana Cayetano Heredia, Lima, Peru; Department of Pediatrics, Children's Hospital of Michigan, Wayne State University School of Medicine/Detroit Medical Center, Detroit, Mich.
5
Knowledge and Evaluation Research Unit, Mayo Clinic, Rochester, Minn.
6
Mayo Clinic Libraries, Mayo Clinic, Rochester, Minn.
7
Knowledge and Evaluation Research Unit, Mayo Clinic, Rochester, Minn; Unidad de Conocimiento y Evidencia, Universidad Peruana Cayetano Heredia, Lima, Peru; Department of Internal Medicine, Henry Ford Hospital, Detroit, Mich.
8
Knowledge and Evaluation Research Unit, Mayo Clinic, Rochester, Minn; Division of Endocrinology, Diabetes, Metabolism, and Nutrition, Mayo Clinic, Rochester, Minn; Department of Health Sciences Research, Division of Health Care Policy and Research, Mayo Clinic, Rochester, Minn.
9
Knowledge and Evaluation Research Unit, Mayo Clinic, Rochester, Minn; Department of Health Sciences Research, Division of Health Care Policy and Research, Mayo Clinic, Rochester, Minn. Electronic address: LeBlanc.Annie@mayo.edu.

Abstract

BACKGROUND:

Little is known about the impact of interventions to support shared decision making (SDM) with pediatric patients.

OBJECTIVES:

To summarize the efficacy of SDM interventions in pediatrics on patient-centered outcomes.

DATA SOURCES:

We searched Ovid Medline, Ovid Embase, Ovid Cochrane Library, Web of Science, Scopus, and Ovid PsycInfo from database inception to December 30, 2013, and performed an environmental scan.

STUDY ELIGIBILITY CRITERIA:

We included interventions designed to engage pediatric patients, parents, or both in a medical decision, regardless of study design or reported outcomes.

STUDY APPRAISAL AND SYNTHESIS METHODS:

We reviewed all studies in duplicate for inclusion, data extraction, and risk of bias assessment. Meta-analysis was performed on 3 outcomes: knowledge, decisional conflict, and satisfaction.

RESULTS:

Sixty-one citations describing 54 interventions met eligibility criteria. Fifteen studies reported outcomes such that they were eligible for inclusion in meta-analysis. Heterogeneity across studies was high. Meta-analysis revealed SDM interventions significantly improved knowledge (standardized mean difference [SMD] 1.21, 95% confidence interval [CI] 0.26 to 2.17, P = .01) and reduced decisional conflict (SMD -1.20, 95% CI -2.01 to -0.40, P = .003). Interventions showed a nonsignificant trend toward increased satisfaction (SMD 0.37, 95% CI -0.04 to 0.78, P = .08).

LIMITATIONS:

Included studies were heterogeneous in nature, including their conceptions of SDM.

CONCLUSIONS AND IMPLICATIONS OF KEY FINDINGS:

A limited evidence base suggests that pediatric SDM interventions improve knowledge and decisional conflict, but their impact on other outcomes is unclear.

SYSTEMATIC REVIEW REGISTRATION NUMBER:

PROSPERO CRD42013004761 (http://www.crd.york.ac.uk/PROSPERO/display_record.asp?ID=CRD42013004761).

KEYWORDS:

adolescent; child; child, preschool; decision aids; decision making; decision making, shared; decision support techniques; infant; infant, newborn; pediatrics

PMID:
25983006
DOI:
10.1016/j.acap.2015.03.011
[Indexed for MEDLINE]

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