Evaluation of Shared Decision-Making Interventions in Pediatric Acute Care: A Systematic Review.

Abstract

Context: There is limited consensus on the effectiveness of shared decision-making (SDM) interventions in pediatric acute care, where implementing SDM is particularly challenging.

Objective: To conduct a systematic review on the effectiveness of SDM interventions in pediatric acute care settings (PROSPERO: CRD42023394760).

Data sources: MEDLINE, EMBASE, Cochrane Library, CINAHL, Web of Science, Scopus, and PsycInfo databases from inception to November 12, 2024.

Study selection: Studies that evaluated SDM intervention effectiveness for managing acute medical problems-those requiring an urgent or time-sensitive decision at the current clinical visit-in children and youth (aged <19 years).

Data extraction: Data were extracted on study participants, study design, clinical decision assessed, and patient-centered and clinical outcomes evaluated.

Results: Of 10 278 articles identified, 27 studies were included. These studies focused on acute respiratory infection (n = 5), intensive care unit decision (n = 5), head injury (n = 4), appendicitis (n = 4), febrile infant (n = 3), and other care decisions (n = 6). A breadth of outcome measures and measurement tools were used. In general, SDM interventions had positive impacts on patient-centered and clinical outcomes and were not accompanied by increased resource use, repeat health care utilization, or complications.

Limitations: Heterogeneity in SDM interventions and outcome measures limited the ability to conduct meta-analyses on intervention effectiveness.

Conclusions: SDM interventions have been evaluated in several pediatric acute care settings. Across a range of studies, SDM interventions were observed to improve patient-centered outcomes without increasing complications. Additional research using standardized outcome measurements is needed.