A Push for Progress With Shared Decision-making in Pediatrics

* Abbreviation: SDM — : shared decision-making Shared decision-making (SDM) is a decision-making model in which “both parties share information…take steps to build consensus about the preferred treatment, and [reach an agreement] on the treatment to implement.”1 It exists on a continuum between 2 extremes (decision-making driven solely by the patient or by the physician) and represents a balance between patient and physician decisional responsibility that is guided by the patient and calibrated to the clinical context.2 At its inception, SDM was proposed to be the “ideal for the physician–patient relationship” as medicine pivoted from paternalism.3 It is now the standard decision-making model in medicine. Despite SDM’s prominence, however, problems linger. The evidence to support the purported benefits of SDM (increased patient understanding and satisfaction, improved adherence, and better health outcomes) is equivocal.4 Physicians are also struggling with how to practice SDM.5 In addition, little is known about how SDM should be applied in the pediatric setting. The gap in our understanding of SDM in pediatrics exists in part because initial frameworks used to develop the concept of SDM were based on the clinical context of a competent adult patient facing an acute, one-time intervention for the treatment of disease. This single, simplistic dyadic scenario has also served as the basis for subsequent analyses of SDM, its features, and tools to facilitate it. Analyses of SDM for scenarios common in pediatrics, such … Address correspondence to Douglas J. Opel, MD, MPH, Seattle Children’s Research Institute, 1900 Ninth Ave, Mail Stop JMB-6, Seattle, WA 98101. E-mail: douglas.opel{at}seattlechildrens.org