Barriers and facilitators of pediatric shared decision-making: a systematic review

Laura Boland,Audrey Yameogo,Allyson Shephard,Alexandra Davis,Janet Jull,Dawn Stacey,Margaret L Lawson,Krystina Lewis,France Légaré,Ian D Graham

doi:10.1186/s13012-018-0851-5

Abstract

BackgroundShared decision-making (SDM) is rarely implemented in pediatric practice. Pediatric health decision-making differs from that of adult practice. Yet, little is known about the factors that influence the implementation of pediatric shared decision-making (SDM). We synthesized pediatric SDM barriers and facilitators from the perspectives of healthcare providers (HCP), parents, children, and observers (i.e., persons who evaluated the SDM process, but were not directly involved).MethodsWe conducted a systematic review guided by the Ottawa Model of Research Use (OMRU). We searched MEDLINE, EMBASE, Cochrane Library, CINAHL, PubMed, and PsycINFO (inception to March 2017) and included studies that reported clinical pediatric SDM barriers and/or facilitators from the perspective of HCPs, parents, children, and/or observers. We considered all or no comparison groups and included all study designs reporting original data. Content analysis was used to synthesize barriers and facilitators and categorized them according to the OMRU levels (i.e., decision, innovation, adopters, relational, and environment) and participant types (i.e., HCP, parents, children, and observers). We used the Mixed Methods Appraisal Tool to appraise study quality.ResultsOf 20,008 identified citations, 79 were included. At each OMRU level, the most frequent barriers were features of the options (decision), poor quality information (innovation), parent/child emotional state (adopter), power relations (relational), and insufficient time (environment). The most frequent facilitators were low stake decisions (decision), good quality information (innovation), agreement with SDM (adopter), trust and respect (relational), and SDM tools/resources (environment). Across participant types, the most frequent barriers were insufficient time (HCPs), features of the options (parents), power imbalances (children), and HCP skill for SDM (observers). The most frequent facilitators were good quality information (HCP) and agreement with SDM (parents and children). There was no consistent facilitator category for observers. Overall, study quality was moderate with quantitative studies having the highest ratings and mixed-method studies having the lowest ratings.ConclusionsNumerous diverse and interrelated factors influence SDM use in pediatric clinical practice. Our findings can be used to identify potential pediatric SDM barriers and facilitators, guide context-specific barrier and facilitator assessments, and inform interventions for implementing SDM in pediatric practice.Trial RegistrationPROSPERO CRD42015020527

Highlights

Shared decision-making (SDM) is an evidenced-based approach that promotes collaboration between patients, family members, and healthcare providers (HCP) when making health decisions
Barriers and facilitators were reported from the perspective of HCPs (n = 19), parents (n = 18), children (n = 8), multiple perspectives (n = 26), and observers (n = 7)
Pediatric SDM barriers and facilitators We report our findings in several formats, including a narrative report of frequently cited barriers and facilitators under each OMRU level, a detailed taxonomy of pediatric SDM barriers and facilitators, including frequency counts across OMRU levels and participant types (Table 4), and influential factors mapped to the OMRU (Fig. 3)

Summary

Introduction

Shared decision-making (SDM) is an evidenced-based approach that promotes collaboration between patients, family members, and healthcare providers (HCP) when making health decisions. By exchanging information about the evidence (options, risks, and benefits) and the patient and family’s preferences and values, HCPs, patients, and family members can deliberate to determine the best treatment plan [1]. This approach to decision-making is considered essential for patient-centered care, has garnered increasing international support among policy makers, and is recommended by pediatric regulatory organizations [2–4]. Determining the barriers and facilitators that influence the clinical use of evidence-based practices are critical for promoting their uptake [7]. We synthesized pediatric SDM barriers and facilitators from the perspectives of healthcare providers (HCP), parents, children, and observers (i.e., persons who evaluated the SDM process, but were not directly involved)

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Results

Discussion

Conclusion