Shared decision making (SDM) between providers, patients, and their families is associated with improved patient satisfaction and health outcomes and has emerged as an essential clinical tool in the inpatient setting. In pediatrics, many providers view SDM as a way to incorporate parental values into the medical decision-making process, but is this really how parents see it? That is the question that Hoang et al (10.1542/hpeds.2020-0075) sought to answer in their Hospital Pediatrics article, “Shared Decision Making with Parents of Hospitalized Children: A Qualitative Analysis of Parents’ and Providers’ Perspectives.” In this study, 27 parents and 16 faculty each underwent ~45 minute semi-structured interviews to assess their perceptions of SDM during hospitalization. Parent and provider dyads were interviewed on the same day to capture their perspectives of the same patient conversations.
Providers and parents had different perceptions on the most important aspects of SDM. Providers perceived SDM as a process where they discuss different treatment options with parents, their advantages and disadvantages, and arrive at a decision together. On the other hand, parents prioritized receiving an understandable explanation of the medical diagnosis and treatment options as well as feeling heard during the process over actually contributing to the final decision. This demonstrates an important disconnect between providers and parents regarding the goals of SDM, and, therefore, represents an area where we as pediatricians can do better to meet the needs of our patients and their families.
Study participants identified several barriers to effective SDM and strategies to facilitate the SDM process. Low health literacy, language barriers, cultural differences, stress during hospitalization and even family-centered rounds were all brought up as factors that could hinder SDM. While family-centered rounds can be beneficial, their learner-led nature, time constraints, and associated crowds they bring to the child’s bedside can sometimes deter parents from voicing their thoughts and questions. Study participants identified several ways to improve the SDM process, such as faculty role modeling of effective SDM during family-centered rounds, making time for one-on-one conversations between parents and providers after rounds, and using interactive technology and decision aids to make abstract concepts more concrete.
While there is much to learn about the perceptions of SDM, the authors’ findings open doors for future studies to test interventions aimed at improving SDM during hospitalization. We have a lot to learn, and who better to learn from than the intended beneficiaries – patients and their families.