575 - Characterizing how pediatric clinicians create choice awareness when performing shared decision-making

Publication Number: 575.4186

Holly H. Vo, Seattle Children's, Seattle, WA, United States; Jeff Robinson, Portland State University, Portland, OR, United States; Douglas J.. Opel, Seattle Children's Research Institute, Seattle, WA, United States

Background: Though there is consensus that a core component of shared decision-making (SDM) is creating choice awareness, there is little understanding of how clinicians operationalize this component of SDM.

Objective: To characterize how pediatric clinicians create choice awareness when performing SDM through observation of actual encounters.

Design/Methods: We conducted a secondary analysis of a cross-sectional observational study designed to characterize the decision-making processes of parents and clinicians across a range of medical decisions in different pediatric settings. For the observational study, clinicians were recruited from 6 pediatric specialties (craniofacial, hematology and oncology, hospital medicine, neonatology, pulmonary, and sports medicine) at a single U.S. children’s hospital. We videotaped inpatient care conferences and outpatient problem-oriented encounters and conducted individual post-encounter interviews with parents and clinicians about the decisions they made in those encounters. For the secondary analysis, we identified all videotaped encounters that included a decision in which the clinician stated in their post-encounter interview that there were multiple options and they were performing SDM. With this sample, we used conversation analysis to characterize how clinicians created choice awareness.

Results: There were 31 shared decisions from 21 videotaped encounters included in analysis. We found two overarching approaches clinicians used to create choice awareness: (1) presenting one option and recommending it as the next step in management without making other options explicit, though allowing those options to emerge as needed (single-option approach) or (2) making it explicit up-front that there were multiple options (multiple-options approach).

Conclusion(s): There is variation in how pediatric clinicians communicate choice awareness. Though both the single-option and multiple-options approaches could facilitate SDM, the multiple-options approach does so most unambiguously. Using the multiple options approach can help facilitate discussions that explore different options and how they may align with the family’s goals. With use of the single-option approach, it may be unclear to families that more than one option exists, undermining their involvement and the clinician’s intention to do SDM. Further study of the outcomes of each approach are needed, as is standardization of communicating choice awareness in order to improve implementation of SDM.