Abstract
Adolescence is a period of growing independence and maturity, within the period oflegal minority. As parents or guardians are socially and legally responsible for adolescents' medical decisions, shared decision-making in adolescent healthcare could be ethically challenging. This review aims to identify and map the ethical tensions in shared decision-making in adolescent healthcare. We systematically searched the literature following the PRISMA guidelines to identify relevant articles, which were analyzed using the review of reasons methodology Strech and Sofaer (J Med Ethics 38(2):121-6, 2012). We included 38 articles which involved adolescents, healthcare professionalsand parents as being the main stakeholders. Shared decision-making was influenced not only by individual stakeholders' characteristics, but by tensions between stakeholder dyads. Most studiessupported the involvement of the adolescent in decision-making, depending on their life experience, decision-making capacity and clinical condition. Shared decision-making in adolescent health is receiving increasing attention. However, questions remain on what this concept entails, the roles and involvement of stakeholders and its practical implementation. • Although adolescents wish to be involved in health decisions, shared decision-makingin adolescents is underexplored • Adolescentshared decision-making is different from pediatric and adult shared decision-making, and is ethically complex due to the adolescent's growing autonomy What is new: • Adolescent SDM involves three-way interactions between the adolescent, healthcare professionaland parents • In adolescent shared decision-making, involving or excluding a stakeholder and sharing or withholding information are ethically value-laden steps • Research is needed to further understand the roles of adolescents' personal value systems, extended or reconstituted families and decision aids in shared decision-making.
Published Version
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