Article type
Year
Abstract
Background: Shared Decision-Making (SDM) involves patients and carers in the process of making healthcare decisions; drawing on both clinicians' expertise, and patients' and carers' experience and values. The socio-medical nature of SDM and a lack of consensus about the structure of SDM interventions for children suggest the need to understand the context and content of interventions before any assessment of efficacy can be made.
Objectives: To provide a comprehensive understanding of SDMs potential for improving children’s clinical and social outcomes and doctor-patient relationships through a systematic assessment of the clarity and relevance of research evidence in addition to its quality and direction of effect.
Methods: Drawing on previous research and theory a four component model of SDM for children was developed and validated by a synthesis of qualitative research. The validated model provided a benchmark by which to assess SDM interventions. Trials of interventions addressing at least one of the model’s four components were included in a review of effects and quality appraised. In order to provide clarity about the relevance and robustness of the evidence on SDM a 'framework’ approach was used to make clear: • the theoretical context of each intervention; • the coverage of each of the four SDM components; and • the dilution of the intervention by non-SDM components.
Results: Evidence from four sound trials suggests individual SDM components can improve childrenás health and experience of chronic conditions and improve practitioner-patient relationships. However, no studies were found that explicitly aimed to evaluate SDM as a holistic intervention, none comprehensively covered all four components and all included other non-SDM components.
Conclusions: Further trials research is needed to determine the efficacy of SDM as a holistic and theoretically embedded intervention. Understanding the exact nature of interventions and their guiding principles enabled a deeper understanding of evidence on SDM.
Objectives: To provide a comprehensive understanding of SDMs potential for improving children’s clinical and social outcomes and doctor-patient relationships through a systematic assessment of the clarity and relevance of research evidence in addition to its quality and direction of effect.
Methods: Drawing on previous research and theory a four component model of SDM for children was developed and validated by a synthesis of qualitative research. The validated model provided a benchmark by which to assess SDM interventions. Trials of interventions addressing at least one of the model’s four components were included in a review of effects and quality appraised. In order to provide clarity about the relevance and robustness of the evidence on SDM a 'framework’ approach was used to make clear: • the theoretical context of each intervention; • the coverage of each of the four SDM components; and • the dilution of the intervention by non-SDM components.
Results: Evidence from four sound trials suggests individual SDM components can improve childrenás health and experience of chronic conditions and improve practitioner-patient relationships. However, no studies were found that explicitly aimed to evaluate SDM as a holistic intervention, none comprehensively covered all four components and all included other non-SDM components.
Conclusions: Further trials research is needed to determine the efficacy of SDM as a holistic and theoretically embedded intervention. Understanding the exact nature of interventions and their guiding principles enabled a deeper understanding of evidence on SDM.