Characterizing How Pediatric Clinicians Create Choice Awareness When Performing Shared Decision-Making.

Objective: To characterize how clinicians create choice awareness when performing shared decision-making (SDM).

Methods: We conducted a secondary analysis of a cross-sectional observational study designed to characterize the decision-making processes of parents and clinicians across a range of medical decisions in different pediatric settings. For the observational study, clinicians were recruited from 6 pediatric specialties (craniofacial, hematology and oncology, hospital medicine, neonatology, pulmonary, and sports medicine) at a single US children's hospital. We videotaped inpatient care conferences and outpatient problem-oriented encounters. We then conducted individual post-encounter interviews with parents and clinicians about the decisions they made in those encounters. For the secondary analysis, we identified all videotaped encounters that included a decision in which the clinician stated in their post-encounter interview that there were multiple options and they were performing SDM. With this sample, we used conversation analysis to characterize how clinicians created choice awareness.

Results: There were 34 shared decisions from 21 videotaped encounters included in analysis. We found 2 overarching approaches clinicians used to create choice awareness: (1) presenting one option and recommending it as the next step in management without making other options explicit, though allowing those options to emerge as needed (single-option approach) or (2) making it explicit up-front that there were multiple options (multiple-options approach). Though both approaches could facilitate SDM, the multiple-options approach does so most unambiguously.

Conclusions: There is variation in how pediatric clinicians create choice awareness, an essential element of SDM. Further standardization of communicating choice awareness can improve implementation of SDM.