A Guide to Pediatricians’ Active Listening: Considering Context and Family Values in SDM
| Context: Unique Family Characteristics Affecting the Decision-Making Process . | Values: Unique Child/Family Attitudes and Belief Systems Affecting the Decision-Making Process . | Pediatrician’s Ability to Inform and Clarify in the SDM Process . |
|---|---|---|
| • Family’s understanding of diagnosis | Quality-of-life considerations: | • Adequacy of information is addressed |
| • Child’s involvement based on developmental status | • Child’s enjoyment of activities of daily living is addressed (self- and proxy report) | • Accuracy and quality of information is addressed |
| • Adolescent’s capability, values, and preference for involvement • Family’s understanding of the child’s physical, social, emotional status/prognosis • Family’s understanding of implications of intervention being considered o Health team is seen as listening, understanding, supportive o Parents’ previous experiences in difficult decisions o Decision-making process: parents’ styles/preferences o Decision-making process: extended family influence/support o Decision-making process: external influences (school, finance, others) o Health literacy of the family, including the patient • Health professionals’ understanding of barriers to the family’s/child’s full participation in the SDM process | • Child’s comfort is addressed (self- and proxy report) • Financial considerations (cost/benefits) are addressed • Emotional status and social interactions are addressed • Unique ethnic, cultural characteristics affecting health beliefs Health-related quality-of-life considerations • Personal competence and self-directed skills are addressed • Educational planning is addressed • Participation in recreation/leisure activity • Family or significant-other personal support (caregiver’s perceived roles/investment) • Personal rights and social inclusion are optimized • Healthy weight and growth attained • No food insecurity or unaddressed nutritional issues • Concerns of medical/surgical complications | • Timing of information is appropriate • Support of “peer-to-peer” interactions is addressed • Clarifications are continually addressed: o Family does not feel “pressured” to decide o Support team seems present and will be over time |
| Context: Unique Family Characteristics Affecting the Decision-Making Process . | Values: Unique Child/Family Attitudes and Belief Systems Affecting the Decision-Making Process . | Pediatrician’s Ability to Inform and Clarify in the SDM Process . |
|---|---|---|
| • Family’s understanding of diagnosis | Quality-of-life considerations: | • Adequacy of information is addressed |
| • Child’s involvement based on developmental status | • Child’s enjoyment of activities of daily living is addressed (self- and proxy report) | • Accuracy and quality of information is addressed |
| • Adolescent’s capability, values, and preference for involvement • Family’s understanding of the child’s physical, social, emotional status/prognosis • Family’s understanding of implications of intervention being considered o Health team is seen as listening, understanding, supportive o Parents’ previous experiences in difficult decisions o Decision-making process: parents’ styles/preferences o Decision-making process: extended family influence/support o Decision-making process: external influences (school, finance, others) o Health literacy of the family, including the patient • Health professionals’ understanding of barriers to the family’s/child’s full participation in the SDM process | • Child’s comfort is addressed (self- and proxy report) • Financial considerations (cost/benefits) are addressed • Emotional status and social interactions are addressed • Unique ethnic, cultural characteristics affecting health beliefs Health-related quality-of-life considerations • Personal competence and self-directed skills are addressed • Educational planning is addressed • Participation in recreation/leisure activity • Family or significant-other personal support (caregiver’s perceived roles/investment) • Personal rights and social inclusion are optimized • Healthy weight and growth attained • No food insecurity or unaddressed nutritional issues • Concerns of medical/surgical complications | • Timing of information is appropriate • Support of “peer-to-peer” interactions is addressed • Clarifications are continually addressed: o Family does not feel “pressured” to decide o Support team seems present and will be over time |