Engaging families in shared decision making in pediatric primary care settings

PROJECT SUMMARY During pediatric primary care and urgent care visits, parents serve as surrogate decision makers for their children, who themselves have evolving developmental contexts and roles in healthcare decision making. When multiple potential choices for care exist, pediatricians and families commonly engage in shared decision making (SDM), which involves collaboration between the physician and parent – as well as the child when developmentally appropriate – to make a healthcare decision. In SDM, the pediatrician elicits parents’ values and goals for their child’s care and engages them to make a healthcare decision that aligns with these values and goals. While there is strong evidence that SDM leads to increased patient satisfaction and improved health outcomes, many patients and physicians do not feel empowered to engage in SDM, and there is a gap in our understanding of the optimal use of SDM in primary care, particularly for well and sick visits among pediatric patients. Further, limited interventions have been developed and rigorously evaluated for use with parents and pediatric patients to facilitate SDM. Because children receive most or all of their healthcare in a primary care setting, it is imperative that we elucidate the factors that support and hinder SDM so that families may make informed decisions in these settings. The proposed project’s overall objective is to identify factors that facilitate SDM in pediatric primary care settings to inform a targeted family engagement intervention for pediatricians to facilitate shared decision making in real-world clinical settings. We will accomplish the project objective through a mixed-methods study with the following aims: 1) Identify baseline experiences, expectations, and determinants of shared decision making among parents in a pediatric primary care setting; 2) Explore pediatricians’ and parents’ perceived challenges and facilitators of SDM in real-world clinical settings; and 3) Develop and evaluate a targeted shared decision-making pilot intervention for pediatricians tailored to facilitate parent engagement in informed decision making in a pediatric primary care setting. This pilot study has the potential to generate contemporary parent-engagement tools to foster physician and parent comfort with facilitating discussions around shared decision making, and ultimately to empower parents to make informed healthcare decisions for their children that align with their values and goals for their child’s care. In the process, I will advance my training by developing 1) expertise in behavioral science and patient engagement, 2) advanced techniques in mixed methods design, 3) expertise in behavioral interventions and implementation science, and 4) leadership and professional development skills to translate my findings into clinical practice. In summary, this research will develop my expertise in mixed methods and behavioral interventions, enabling me to become an independent investigator capable of developing and translating novel shared decision-making interventions to real-world clinical settings, with the ultimate goal of promoting family engagement in informed decision making for children.