Shared Decision Making

Shared decision making is an important part of implementing youth- and family-centered care. It is more complicated to implement in pediatric settings, as families are often the primary decision makers for younger children. Below are some tips based on a 2018 article “A 4-Step Framework for Shared Decision-making in Pediatrics”.

• Step 1: The pediatrician should consider whether the decision includes more than one medically reasonable option that is consistent with the standard of care. If the answer is “no”, then shared decision making is not indicated.
• Step 2: If shared decision making is indicated, the next question to consider is whether one of the options is more favorable than the others. This can relate to benefits to the patient/family or to public health, and burden on the patient/family. Caution should be taken when there is limited evidence.
• Step 3: The pediatrician should seek to understand the family’s values and consider whether they have any preferences in terms of the options available. You should note that family preferences often change, so it is important to have ongoing dialogue and develop a trusted relationship.
• Step 4: The final step is to determine what approach to take with shared decision making based on information from the first 3 steps; whether the decision should be more physician-guided or family-guided.

To justify more physician-guided shared decision making, the following must be present:

• more than 1 medically reasonable option in Step 1
• one clearly favorable option from the medical perspective in Step 2
• the favorable option is not inconsistent with family preference in Step 3.

To justify more family-guided shared decision making, the following must be present:

• more than 1 medically reasonable option in Step 1
• no clearly favorable option from the medical perspective in Step 2
• more than one option that meet the family’s preferences in Step 3. In this instance, the pediatrician should explain the options using language the family understands, clearly outlining the risks and benefits of each. The pediatrician may share their preferred option upon the family’s request.

Another strategy to consider, regardless of the type of shared decision making approach used is to connect patients and/or their families with family-based organizations or other patients/families who have experienced similar circumstances for peer support.

Additional Resource

Shared Decision-Making and Children With Disabilities: Pathways to Consensus