Shared Decision Making in Pediatrics: A Systematic Review and Meta-analysis

Montori, Victor M.; List, Betsy; Brinkman, William B.; LeBlanc, Annie; Wyatt, Kirk D.; Prutsky Lopez, Gabriela; Erwin, Patricia; Wang, Zhen; Domecq Garces, Juan Pablo; Asi, Noor

dc.contributor.author	Wyatt, Kirk D.
dc.contributor.author	List, Betsy
dc.contributor.author	Brinkman, William B.
dc.contributor.author	Prutsky Lopez, Gabriela
dc.contributor.author	Asi, Noor
dc.contributor.author	Erwin, Patricia
dc.contributor.author	Wang, Zhen
dc.contributor.author	Domecq Garces, Juan Pablo
dc.contributor.author	Montori, Victor M.
dc.contributor.author	LeBlanc, Annie
dc.date.accessioned	2019-02-06T14:59:04Z
dc.date.available	2019-02-06T14:59:04Z
dc.date.issued	2015
dc.identifier.uri	https://hdl.handle.net/20.500.12866/5507
dc.description.abstract	BACKGROUND: Little is known about the impact of interventions to support shared decision making (SDM) with pediatric patients. OBJECTIVES: To summarize the efficacy of SDM interventions in pediatrics on patient-centered outcomes. DATA SOURCES: We searched Ovid Medline, Ovid Embase, Ovid Cochrane Library, Web of Science, Scopus, and Ovid PsycInfo from database inception to December 30, 2013, and performed an environmental scan. STUDY ELIGIBILITY CRITERIA: We included interventions designed to engage pediatric patients, parents, or both in a medical decision, regardless of study design or reported outcomes. STUDY APPRAISAL AND SYNTHESIS METHODS: We reviewed all studies in duplicate for inclusion, data extraction, and risk of bias assessment. Meta-analysis was performed on 3 outcomes: knowledge, decisional conflict, and satisfaction. RESULTS: Sixty-one citations describing 54 interventions met eligibility criteria. Fifteen studies reported outcomes such that they were eligible for inclusion in meta-analysis. Heterogeneity across studies was high. Meta-analysis revealed SDM interventions significantly improved knowledge (standardized mean difference [SMD] 1.21, 95% confidence interval [CI] 0.26 to 2.17, P = .01) and reduced decisional conflict (SMD -1.20, 95% CI -2.01 to -0.40, P = .003). Interventions showed a nonsignificant trend toward increased satisfaction (SMD 0.37, 95% CI -0.04 to 0.78, P = .08). LIMITATIONS: Included studies were heterogeneous in nature, including their conceptions of SDM. CONCLUSIONS AND IMPLICATIONS OF KEY FINDINGS: A limited evidence base suggests that pediatric SDM interventions improve knowledge and decisional conflict, but their impact on other outcomes is unclear.	en_US
dc.language.iso	eng
dc.publisher	Elsevier
dc.relation.ispartofseries	Academic Pediatrics
dc.rights	info:eu-repo/semantics/restrictedAccess
dc.subject	Adolescent	en_US
dc.subject	Humans	en_US
dc.subject	Child	en_US
dc.subject	Child, Preschool	en_US
dc.subject	Infant	en_US
dc.subject	decision making	en_US
dc.subject	adolescent	en_US
dc.subject	child	en_US
dc.subject	Infant, Newborn	en_US
dc.subject	Decision Making	en_US
dc.subject	Decision Support Techniques	en_US
dc.subject	Patient Participation	en_US
dc.subject	Pediatrics	en_US
dc.subject	Physician-Patient Relations	en_US
dc.subject	Professional-Family Relations	en_US
dc.subject	child, preschool	en_US
dc.subject	decision aids	en_US
dc.subject	decision making, shared	en_US
dc.subject	decision support techniques	en_US
dc.subject	infant	en_US
dc.subject	infant, newborn	en_US
dc.subject	pediatrics	en_US
dc.title	Shared Decision Making in Pediatrics: A Systematic Review and Meta-analysis	en_US
dc.type	info:eu-repo/semantics/review
dc.identifier.doi	https://doi.org/10.1016/j.acap.2015.03.011
dc.subject.ocde	https://purl.org/pe-repo/ocde/ford#3.02.03
dc.relation.issn	1876-2867