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Validation of a Process for Shared Decision-Making in Pediatrics.
Opel, Douglas J; Vo, Holly Hoa; Dundas, Nicolas; Spielvogle, Heather; Mercer, Amanda; Wilfond, Benjamin S; Clark, Jonna; Heike, Carrie L; Weiss, Elliott M; Bryan, Mersine A; Shah, Seema K; McCarty, Carolyn A; Robinson, Jeffrey D; Blumenthal-Barby, Jennifer; Tilburt, Jon.
Afiliación
  • Opel DJ; 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@seattlechil
  • Vo HH; 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.
  • Dundas N; Treuman Katz Center for Pediatric Bioethics, Seattle Children's Research Institute (N Dundas, H Spielvogle, and A Mercer), Seattle, Wash.
  • Spielvogle H; Treuman Katz Center for Pediatric Bioethics, Seattle Children's Research Institute (N Dundas, H Spielvogle, and A Mercer), Seattle, Wash.
  • Mercer A; Treuman Katz Center for Pediatric Bioethics, Seattle Children's Research Institute (N Dundas, H Spielvogle, and A Mercer), Seattle, Wash.
  • Wilfond BS; 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.
  • Clark J; 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.
  • Heike CL; 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.
  • Weiss EM; 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.
  • Bryan MA; 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.
  • Shah SK; Department of Pediatrics, Northwestern University Feinberg School of Medicine; Bioethics Program, Lurie Children's Hospital (SK Shah), Chicago, Ill.
  • McCarty CA; 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.
  • Robinson JD; Department of Communication, Portland State University (JD Robinson), Portland, Ore.
  • Blumenthal-Barby J; Center for Medical Ethics and Health Policy, Baylor College of Medicine (J Blumenthal-Barby), Houston, Tex.
  • Tilburt J; Division of General Internal Medicine, Department of Internal Medicine, Mayo Clinic (J Tilburt), Scottsdale, Ariz.
Acad Pediatr ; 23(8): 1588-1597, 2023.
Article en En | MEDLINE | ID: mdl-36682451
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.
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Texto completo: 1 Colección: 01-internacional Base de datos: MEDLINE Asunto principal: Toma de Decisiones / Neonatología Tipo de estudio: Guideline / Prognostic_studies Límite: Child / Humans Idioma: En Revista: Acad Pediatr Año: 2023 Tipo del documento: Article Pais de publicación: Estados Unidos
Texto completo
Añadir a Mi BVS
Imprimir
XML
PubMed Links
Buscar en Google

Texto completo: 1 Colección: 01-internacional Base de datos: MEDLINE Asunto principal: Toma de Decisiones / Neonatología Tipo de estudio: Guideline / Prognostic_studies Límite: Child / Humans Idioma: En Revista: Acad Pediatr Año: 2023 Tipo del documento: Article Pais de publicación: Estados Unidos