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Acad Pediatr. 2018 Jan - Feb;18(1):3-7. doi: 10.1016/j.acap.2017.06.009. Epub 2017 Jul 16.

Shared Decision-Making with Parents of Acutely Ill Children: A Narrative Review.

Author information

1
Department of Pediatrics, Yale University School of Medicine, New Haven, Conn; Department of Emergency Medicine, Section of Pediatric Emergency Medicine, Yale University School of Medicine, New Haven, Conn. Electronic address: paul.aronson@yale.edu.
2
Department of Pediatrics, Yale University School of Medicine, New Haven, Conn; Department of Epidemiology of Microbial Diseases, Yale School of Public Health, New Haven, Conn; Department of Investigative Medicine, Yale University, New Haven, Conn.
3
Department of Epidemiology of Microbial Diseases, Yale School of Public Health, New Haven, Conn.
4
Department of Internal Medicine, Section of Rheumatology, Yale School of Medicine, New Haven, Conn; Connecticut Healthcare System, West Haven, Conn.

Abstract

BACKGROUND:

Shared decision-making (SDM) has mostly been used with adults and parents in the primary care setting, and there is limited knowledge on the use of SDM with parents of acutely ill children. The objective of this study was to review the literature on SDM with parents in the management of acutely ill children.

METHODS:

We searched MEDLINE, SCOPUS, PsycINFO, the Cochrane Library, and ClinicalTrials.gov for English language studies published from the time of database inception to February, 2017. Study eligibility criterion was use of SDM with parents for children aged 18 years or younger with an acute medical problem.

RESULTS:

We identified 2 ongoing clinical trials and 10 published studies that met inclusion criteria: 2 using hypothetical SDM scenarios, 1 mixed methods study, and 7 intervention studies. Only 1 study compared an SDM intervention with usual care in a randomized controlled trial. The limited literature shows that parents of acutely ill children have differing preferences for testing and/or treatment, and that they generally want the opportunity to express those preferences through an SDM process. Use of SDM often results in acutely ill children undergoing fewer and/or less intensive testing or treatment, although the effect on outcomes is unclear.

CONCLUSIONS:

Parents welcome participation in SDM for management decisions with their acutely ill child. Further investigation is needed to determine how best to implement SDM with parents of acutely ill children and to assess the effect of SDM on outcomes.

KEYWORDS:

acute disease; adolescent; child; decision-making; emergency service; hospital; infant; newborn; preschool; shared decision-making

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