169 - Defining Competencies for Effective Shared Decision Making in Pediatrics: A consensus study

Publication Number: 169.4158

Vanessa Ivonne Orellana Villazon, Cincinnati Children's Hospital Medical Center, Amelia, OH, United States; Ellen Lipstein, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, United States; Jennifer DeSante-Bertkau, Cincinnati Children's, Cincinnati, OH, United States; Barbara Giambra, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, United States

Background: Pediatric Shared Decision Making (SDM) involves clinicians working with children and families to make healthcare decisions that reflect their values and preferences. Existing pediatric SDM programs are highly variable and rely on frameworks designed for adults, leaving healthcare professionals unprepared for SDM in pediatrics. While efforts have been made to identify SDM competencies in adult care, this has not happened for pediatrics. We sought to fill this gap by identifying the essential competencies for effective SDM in pediatric settings using a Delphi process.

Objective: The objective of this study is to systematically identify essential competencies for clinicians to effectively practice shared decision-making with pediatric patients and their families.

Design/Methods: A modified Delphi method was used, involving three iterative rounds of expert surveys. Forty experts in pediatrics, SDM, and medical education, identified through convenience and snowball sampling, were invited. In the first round, experts were asked to suggest essential competencies for pediatric SDM. We also conducted a literature review to identify competencies from existing pediatric SDM training programs. Both sets were then combined, grouped, and refined through thematic analysis. In the second round, experts rated the refined competencies on a 4-point Likert scale, with consensus defined as a median score >3.25, IQR < 1.75, and 70% agreement. Competencies that did not reach consensus were re-evaluated in a third round. Final refinements followed, and selected competencies were grouped into content domains.

Results: In the first round, 22 experts suggested 176 competencies, which were combined with 170 identified through a literature review. This list was refined to 42 competencies for the second round, where 21 experts rated them. By the end of the second round, 20 competencies reached consensus, while 22, along two additional suggestions, advanced to the third round. In the third round, 14 more competencies reached consensus, resulting in a final set of 34 competencies covering communication skills, child participation, fundamentals of SDM, values and preferences elicitation, evidence-based recommendations, and consensus building. Consensus across rounds was robust, reflecting strong expert agreement on the competencies.

Conclusion(s): This Delphi study established a consensus-based framework of competencies essential for SDM in pediatric care. These competencies will guide the development of a targeted SDM curriculum, aiming to enhance healthcare professionals' ability to share decisions with children and families.

Table 1. Demographics and SDM-Related Experience of Expert Participants
Characteristics and SDM-related experience of 22 experts participating in the Delphi study on pediatric SDM competencies. *Participants could select more than one option in "Professional Role" and "Areas of Expertise in SDM".

Table 2. Competency Framework for Effective Pediatric Shared Decision-Making
A framework outlining essential competencies for healthcare professionals to practice shared decision-making effectively in pediatric settings.