Trainee Involvement in Advancing Pediatric Shared Decision-making.

Abstract

Our next patient was one of many affected by a persistent upper respiratory tract infection during my subinternship. As I listened to the dense, coarse crackling throughout both of her lung fields, the 4-month-old girl launched into another coughing fit. Given her lack of improvement, our team felt strongly that she would benefit from continued observation and supportive care. In the midst of discussing our plan with the family, the mother interrupted, stating firmly, “For the past 4 days, you have ordered test after test, treatment after treatment, and we have gone along with it. But now, we want to take her home. Does our opinion even matter?” After the parents reluctantly agreed with our treatment plan, I walked out of the room wondering, “Did their opinion matter? Could the mother’s frustration stem from our failure to adequately communicate all the aspects of her child’s illness? Did we attempt to balance parental goals of care with what we considered medically necessary?” Shared decision-making is a concept in which health care providers, patients, and their families collaborate to determine what medical course of action is best for the patient. Proper implementation of shared decision-making involves the following 2 critical components: (1) informing patients and their families of the nature of the patient’s illness, including the risks and benefits of potential therapies, and (2) actively engaging them in the medical decision-making process, ensuring that patient and family preferences are both acknowledged and incorporated into the care plan.1 In … Address correspondence to Christopher E. Gaw, MD, MBE, Division of General Pediatrics, Children’s Hospital of Philadelphia, 3401 Civic Center Blvd, Philadelphia, PA 19104. E-mail: gawc{at}email.chop.edu