Barriers and facilitators of pediatric shared decision-making: a systematic review.
Adolescent
Attitude of Health Personnel
Child
Child Health Services
/ organization & administration
Child, Preschool
Clinical Decision-Making
Decision Making
Emotions
Health Services Accessibility
Humans
Implementation Science
Infant
Infant, Newborn
Information Dissemination
Parents
/ psychology
Patient Acceptance of Health Care
/ psychology
Patient Participation
Power, Psychological
Professional-Patient Relations
Workload
Barriers
Facilitators
Implementation
Ottawa Model of Research Use
Pediatrics
Shared decision-making
Systematic review
Taxonomy
Journal
Implementation science : IS
ISSN: 1748-5908
Titre abrégé: Implement Sci
Pays: England
ID NLM: 101258411
Informations de publication
Date de publication:
18 01 2019
18 01 2019
Historique:
received:
26
07
2018
accepted:
27
12
2018
entrez:
20
1
2019
pubmed:
20
1
2019
medline:
14
8
2019
Statut:
epublish
Résumé
Shared decision-making (SDM) is rarely implemented in pediatric practice. Pediatric health decision-making differs from that of adult practice. Yet, little is known about the factors that influence the implementation of pediatric shared decision-making (SDM). We synthesized pediatric SDM barriers and facilitators from the perspectives of healthcare providers (HCP), parents, children, and observers (i.e., persons who evaluated the SDM process, but were not directly involved). We conducted a systematic review guided by the Ottawa Model of Research Use (OMRU). We searched MEDLINE, EMBASE, Cochrane Library, CINAHL, PubMed, and PsycINFO (inception to March 2017) and included studies that reported clinical pediatric SDM barriers and/or facilitators from the perspective of HCPs, parents, children, and/or observers. We considered all or no comparison groups and included all study designs reporting original data. Content analysis was used to synthesize barriers and facilitators and categorized them according to the OMRU levels (i.e., decision, innovation, adopters, relational, and environment) and participant types (i.e., HCP, parents, children, and observers). We used the Mixed Methods Appraisal Tool to appraise study quality. Of 20,008 identified citations, 79 were included. At each OMRU level, the most frequent barriers were features of the options (decision), poor quality information (innovation), parent/child emotional state (adopter), power relations (relational), and insufficient time (environment). The most frequent facilitators were low stake decisions (decision), good quality information (innovation), agreement with SDM (adopter), trust and respect (relational), and SDM tools/resources (environment). Across participant types, the most frequent barriers were insufficient time (HCPs), features of the options (parents), power imbalances (children), and HCP skill for SDM (observers). The most frequent facilitators were good quality information (HCP) and agreement with SDM (parents and children). There was no consistent facilitator category for observers. Overall, study quality was moderate with quantitative studies having the highest ratings and mixed-method studies having the lowest ratings. Numerous diverse and interrelated factors influence SDM use in pediatric clinical practice. Our findings can be used to identify potential pediatric SDM barriers and facilitators, guide context-specific barrier and facilitator assessments, and inform interventions for implementing SDM in pediatric practice. PROSPERO CRD42015020527.
Sections du résumé
BACKGROUND
Shared decision-making (SDM) is rarely implemented in pediatric practice. Pediatric health decision-making differs from that of adult practice. Yet, little is known about the factors that influence the implementation of pediatric shared decision-making (SDM). We synthesized pediatric SDM barriers and facilitators from the perspectives of healthcare providers (HCP), parents, children, and observers (i.e., persons who evaluated the SDM process, but were not directly involved).
METHODS
We conducted a systematic review guided by the Ottawa Model of Research Use (OMRU). We searched MEDLINE, EMBASE, Cochrane Library, CINAHL, PubMed, and PsycINFO (inception to March 2017) and included studies that reported clinical pediatric SDM barriers and/or facilitators from the perspective of HCPs, parents, children, and/or observers. We considered all or no comparison groups and included all study designs reporting original data. Content analysis was used to synthesize barriers and facilitators and categorized them according to the OMRU levels (i.e., decision, innovation, adopters, relational, and environment) and participant types (i.e., HCP, parents, children, and observers). We used the Mixed Methods Appraisal Tool to appraise study quality.
RESULTS
Of 20,008 identified citations, 79 were included. At each OMRU level, the most frequent barriers were features of the options (decision), poor quality information (innovation), parent/child emotional state (adopter), power relations (relational), and insufficient time (environment). The most frequent facilitators were low stake decisions (decision), good quality information (innovation), agreement with SDM (adopter), trust and respect (relational), and SDM tools/resources (environment). Across participant types, the most frequent barriers were insufficient time (HCPs), features of the options (parents), power imbalances (children), and HCP skill for SDM (observers). The most frequent facilitators were good quality information (HCP) and agreement with SDM (parents and children). There was no consistent facilitator category for observers. Overall, study quality was moderate with quantitative studies having the highest ratings and mixed-method studies having the lowest ratings.
CONCLUSIONS
Numerous diverse and interrelated factors influence SDM use in pediatric clinical practice. Our findings can be used to identify potential pediatric SDM barriers and facilitators, guide context-specific barrier and facilitator assessments, and inform interventions for implementing SDM in pediatric practice.
TRIAL REGISTRATION
PROSPERO CRD42015020527.
Identifiants
pubmed: 30658670
doi: 10.1186/s13012-018-0851-5
pii: 10.1186/s13012-018-0851-5
pmc: PMC6339273
doi:
Types de publication
Journal Article
Research Support, Non-U.S. Gov't
Systematic Review
Langues
eng
Pagination
7Subventions
Organisme : CIHR
ID : FDN 143237
Pays : Canada
Références
Health Expect. 2015 Oct;18(5):1299-315
pubmed: 23910566
Acad Pediatr. 2012 Mar-Apr;12(2):117-24
pubmed: 22321814
JPEN J Parenter Enteral Nutr. 2017 Nov;41(8):1336-1347
pubmed: 27503938
Nurs Child Young People. 2016 May 9;28(4):16-22
pubmed: 27156418
J Pediatr. 2014 Jul;165(1):178-183.e1
pubmed: 24795203
J Pediatr Nurs. 2005 Oct;20(5):347-59
pubmed: 16182094
Med Care. 2004 Apr;42(4):328-35
pubmed: 15076809
J Pediatr Psychol. 1996 Aug;21(4):505-16
pubmed: 8863460
Int J Pediatr Otorhinolaryngol. 2016 Oct;89:6-12
pubmed: 27619020
Matern Child Health J. 2015 Feb;19(2):410-8
pubmed: 24880252
Implement Sci. 2006 Aug 09;1:16
pubmed: 16899124
Public Health. 2016 Mar;132:3-12
pubmed: 26872738
Pediatrics. 2011 Jan;127(1):e188-96
pubmed: 21172996
J Pediatr. 2016 Apr;171:307-9.e1-2
pubmed: 26817588
Health Aff (Millwood). 2013 Feb;32(2):276-84
pubmed: 23381520
Pediatrics. 2006 Aug;118(2):723-30
pubmed: 16882829
BMC Psychiatry. 2013 Dec 12;13:335
pubmed: 24330307
Pediatrics. 2010 Aug;126(2):306-14
pubmed: 20624804
Pediatr Blood Cancer. 2017 Apr;64(4):
pubmed: 28221731
J Asthma. 2011 Dec;48(10):1022-31
pubmed: 22022958
J Pediatr Orthop. 2015 Dec;35(8):831-7
pubmed: 25551784
Soc Sci Med. 2004 Sep;59(5):1071-9
pubmed: 15186906
Patient Educ Couns. 2014 Mar;94(3):291-309
pubmed: 24305642
Cochrane Database Syst Rev. 2016 Nov 29;11:CD008970
pubmed: 27898175
Clin Child Psychol Psychiatry. 2016 Jan;21(1):19-31
pubmed: 25178946
Cancer. 2015 Dec 15;121(24):4416-24
pubmed: 26348790
Psychooncology. 2016 Aug;25(8):990-3
pubmed: 26374499
BMC Med Inform Decis Mak. 2007 Jun 15;7:16
pubmed: 17573961
Nurs Ethics. 2002 Nov;9(6):583-98
pubmed: 12449996
Qual Health Res. 2005 Nov;15(9):1277-88
pubmed: 16204405
Br J Gen Pract. 2007 Nov;57(544):866-71
pubmed: 17976287
Soc Sci Med. 1997 Mar;44(5):681-92
pubmed: 9032835
Int J Nurs Stud. 2009 Apr;46(4):529-46
pubmed: 19233357
Med Decis Making. 2012 May-Jun;32(3):E22-33
pubmed: 22505617
Fam Syst Health. 2009 Sep;27(3):249-66
pubmed: 19803619
Acad Pediatr. 2016 Aug;16(6):571-8
pubmed: 27132050
Open Med. 2009;3(3):e123-30
pubmed: 21603045
Epilepsy Behav. 2016 Aug;61:185-191
pubmed: 27371883
J Clin Psychol Med Settings. 2014 Sep;21(3):234-43
pubmed: 24952739
Paediatr Nurs. 2001 Jun;13(5):31-5
pubmed: 12025690
Int J Nurs Stud. 2015 Jan;52(1):500-1
pubmed: 25241931
Eur J Oncol Nurs. 2014 Jun;18(3):273-80
pubmed: 24629505
J Pediatr Nurs. 2006 Oct;21(5):350-61
pubmed: 16980135
N Engl J Med. 2012 Mar 1;366(9):780-1
pubmed: 22375967
J Interprof Care. 2011 Jan;25(1):18-25
pubmed: 20795835
J Child Health Care. 2012 Sep;16(3):293-304
pubmed: 23027522
J Clin Nurs. 2016 Apr;25(7-8):1035-44
pubmed: 26879522
Pediatrics. 2013 Nov;132(5):789-91
pubmed: 24101771
Implement Sci. 2018 Mar 9;13(1):40
pubmed: 29523167
Med Decis Making. 2015 Apr;35(3):403-8
pubmed: 25145576
Soc Sci Med. 2009 Jul;69(1):1-8
pubmed: 19464097
Implement Sci. 2008 Jul 16;3:36
pubmed: 18631386
BMC Palliat Care. 2017 Jan 25;16(1):12
pubmed: 28122549
Z Evid Fortbild Qual Gesundhwes. 2017 Jun;123-124:1-5
pubmed: 28546053
J Adolesc Health. 2013 Aug;53(2):253-9
pubmed: 23561895
Paediatr Nurs. 2007 Jul;19(6):14-8
pubmed: 17694888
Cochrane Database Syst Rev. 2012 Oct 17;10:CD004811
pubmed: 23076908
J Trop Pediatr. 2005 Feb;51(1):11-6
pubmed: 15601654
J Clin Nurs. 2006 Jan;15(1):61-71
pubmed: 16390525
Pediatrics. 2009 Nov;124 Suppl 3:S306-14
pubmed: 19861485
Patient Educ Couns. 2014 Sep;96(3):281-6
pubmed: 25034637
Patient Educ Couns. 2008 Dec;73(3):526-35
pubmed: 18752915
J Clin Nurs. 2017 Sep;26(17-18):2657-2668
pubmed: 28001330
PLoS One. 2014 Apr 15;9(4):e94670
pubmed: 24736389
J Clin Nurs. 2017 Jan;26(1-2):215-224
pubmed: 27459947
Matern Child Health J. 2014 Aug;18(6):1316-27
pubmed: 24052119
Patient Educ Couns. 2016 Jan;99(1):61-7
pubmed: 26298218
Oncologist. 2012;17(6):881-5
pubmed: 22615217
Acad Pediatr. 2015 Nov-Dec;15(6):573-83
pubmed: 25983006
J Nurs Adm. 2015 Mar;45(3):152-7
pubmed: 25689501
J Nurs Scholarsh. 2016 May;48(3):265-75
pubmed: 27061758
Pediatr Rheumatol Online J. 2013 Sep 30;11(1):34
pubmed: 24079577
Health Soc Care Community. 2006 Mar;14(2):116-24
pubmed: 16460361
BMC Pediatr. 2007 Nov 09;7:35
pubmed: 17996108
BMC Med Inform Decis Mak. 2015 Feb 07;15:5
pubmed: 25889602
Can Fam Physician. 2017 Sep;63(9):682-684
pubmed: 28904031
Stud Health Technol Inform. 2013;192:23-7
pubmed: 23920508
Adm Policy Ment Health. 2015 Nov;42(6):767-74
pubmed: 25577238
Arch Pediatr Adolesc Med. 2011 Nov;165(11):1013-9
pubmed: 22065181
J Clin Nurs. 2001 Jan;10(1):70-8
pubmed: 11820240
Acad Pediatr. 2013 Mar-Apr;13(2):122-32
pubmed: 23356961
BMC Pediatr. 2014 Apr 23;14:109
pubmed: 24758566
Health Expect. 1999 May;2(2):105-117
pubmed: 11281884
Can J Diabetes. 2013 Apr;37 Suppl 1:S1-3
pubmed: 24070926
J Clin Oncol. 2011 May 20;29(15):2085-90
pubmed: 21464400
J Pediatr Hematol Oncol. 2014 Oct;36(7):559-65
pubmed: 24577546
J Child Health Care. 2013 Dec;17(4):338-53
pubmed: 23411658
Child Care Health Dev. 2011 Jul;37(4):533-9
pubmed: 20854447
Acad Pediatr. 2019 Jan - Feb;19(1):118-129
pubmed: 29860134
Paediatr Child Health. 2004 Feb;9(2):99-114
pubmed: 19654990
Cochrane Database Syst Rev. 2018 Jul 19;7:CD006732
pubmed: 30025154
J Clin Nurs. 2011 Aug;20(15-16):2334-43
pubmed: 21410571
Arch Pediatr Adolesc Med. 2009 Sep;163(9):783-8
pubmed: 19736330
Patient Educ Couns. 2016 Feb;99(2):236-42
pubmed: 26324111
Paediatr Child Health. 2016 Apr;21(3):e17-21
pubmed: 27398058
Nurs Ethics. 2002 Mar;9(2):202-14
pubmed: 11944209
Cochrane Database Syst Rev. 2017 Apr 12;4:CD001431
pubmed: 28402085
Patient Educ Couns. 2005 Jun;57(3):327-32
pubmed: 15893216
Eur J Pediatr. 2016 Sep;175(9):1147-1155
pubmed: 27480942
Arch Pediatr. 2005 Jul;12(7):1068-74
pubmed: 15964521
Health Commun. 2012;27(5):498-505
pubmed: 22077742
Cochrane Database Syst Rev. 2010 Mar 17;(3):CD005470
pubmed: 20238340
Fam Syst Health. 2014 Mar;32(1):116-21
pubmed: 24447150
Acta Paediatr. 2010 Oct;99(10):1464-6
pubmed: 21050268
J Pediatr Health Care. 2016 Jul-Aug;30(4):374-80
pubmed: 26547482
PLoS Med. 2012;9(3):e1001185
pubmed: 22412356
Indian J Pediatr. 2014 Dec;81(12):1287-92
pubmed: 24752630
BMC Ophthalmol. 2015 Aug 22;15:112
pubmed: 26296859
PLoS One. 2016 Nov 28;11(11):e0166151
pubmed: 27893823