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.
Citing Articles
Implementation suggestions for shared decision-making: results from a comparative study of inpatients and outpatients experience surveys.
Tian C, Wong E, Qiu H, Liu S, Wang K, Wei Y
BMC Health Serv Res. 2025; 25(1):362.
PMID: 40069780
PMC: 11895247.
DOI: 10.1186/s12913-025-12507-0.
Caregivers and multidisciplinary team members' perspectives on shared decision making in Duchenne muscular dystrophy: A qualitative study.
Schoefs E, Desmet T, Lerinckx E, Waele L, Geuens S, Pelicaen C
Orphanet J Rare Dis. 2025; 20(1):113.
PMID: 40065476
PMC: 11895160.
DOI: 10.1186/s13023-025-03555-0.
It's About the Journey - Capturing Stories of the Fluctuating Experiences of Youth Kidney Transplant Patients.
Dunbar J, Pratt W, Bascom E, Currier C, Tan Garcia J, Smith J
Proc ACM Hum Comput Interact. 2025; 8(CSCW1).
PMID: 39950037
PMC: 11824542.
DOI: 10.1145/3653704.
Improving asthma care in children: revealing needs and bottlenecks through in-depth interviews.
Gijsen C, van Rossem C, Muris J, van Horck M, Dompeling E
NPJ Prim Care Respir Med. 2024; 34(1):42.
PMID: 39695123
PMC: 11655526.
DOI: 10.1038/s41533-024-00406-6.
How to meet coping strategies and preferences of children during invasive medical procedures: perspectives of healthcare professionals.
Segers E, van den Hoogen A, Schoonhoven L, van de Putte E, Ketelaar M
Eur J Pediatr. 2024; 183(12):5291-5301.
PMID: 39384648
PMC: 11527922.
DOI: 10.1007/s00431-024-05802-1.
Decision-making for children and adolescents: a scoping review of interventions increasing participation in decision-making.
Bosch I, Siebel H, Heiser M, Inhestern L
Pediatr Res. 2024; .
PMID: 39370449
DOI: 10.1038/s41390-024-03509-5.
Beyond the healthcare system: The societal and contextual factors impacting parents' participation in decision-making for neonates with life-threatening conditions.
Oskouie F, Khanjari S, Banazadeh M
PLoS One. 2024; 19(9):e0309914.
PMID: 39240963
PMC: 11379267.
DOI: 10.1371/journal.pone.0309914.
Shared decision-making in adolescent healthcare: a literature review of ethical considerations.
Sobode O, Jegan R, Toelen J, Dierickx K
Eur J Pediatr. 2024; 183(10):4195-4203.
PMID: 39167164
DOI: 10.1007/s00431-024-05687-0.
Enhancing informed consent through multimedia tools in pediatric spinal surgery: a comprehensive review.
Rosa Filezio M, Sharma N, Thull-Freedman J, Ferri-de-Barros F, Santana M
Front Pediatr. 2024; 12:1357462.
PMID: 39100648
PMC: 11294088.
DOI: 10.3389/fped.2024.1357462.
Facilitators and Barriers to Shared Decision-Making Communication Between Latina Mothers and Pediatric Mental Healthcare Providers.
Wallace D, Hale K, Guzman L, Stein G, Jolles M, Sleath B
Health Commun. 2024; 1-12.
PMID: 38982623
PMC: 11711327.
DOI: 10.1080/10410236.2024.2375791.
Fifteen-minute consultation: Empowering children, young people and families through shared decision-making: a practical guide.
Nagra A, Fuller I, Connett G, Reynolds B, Tyerman K, Wallace D
Arch Dis Child Educ Pract Ed. 2024; 109(6):264-270.
PMID: 38937065
PMC: 11671968.
DOI: 10.1136/archdischild-2023-325513.
Exploring needs and requirements for a prototype device measuring physical activity in pediatric physical therapy: A qualitative study.
Engels B, Kloek C, Sol M, Bolster E, Kotte E, Wittink H
PLoS One. 2024; 19(6):e0305968.
PMID: 38917177
PMC: 11198827.
DOI: 10.1371/journal.pone.0305968.
Understanding family-level decision-making when seeking access to acute surgical care for children: Protocol for a cross-sectional mixed methods study.
Hall B, Tegge A, Cotache Condor C, Rhoads M, Wattsman T, Witcher A
PLoS One. 2024; 19(6):e0304165.
PMID: 38913675
PMC: 11195935.
DOI: 10.1371/journal.pone.0304165.
ADHD Prevalence Rose, Yet Disparities Remain: Commentary on the 2022 National Survey of Children's Health.
Chronis-Tuscano A, Bounoua N
J Clin Child Adolesc Psychol. 2024; 53(3):361-372.
PMID: 38905157
PMC: 11193851.
DOI: 10.1080/15374416.2024.2359075.
A systematic review of in-person versus remotely delivered interventions for youth with chronic pain.
MacKenzie N, Marbil M, Soltani S, Lorenzetti D, Birnie K
Paediatr Neonatal Pain. 2024; 6(2):35-43.
PMID: 38863459
PMC: 11163229.
DOI: 10.1002/pne2.12119.
Exploring shared decision-making needs in lung cancer screening among high-risk groups and health care providers in China: a qualitative study.
Lin X, Wang F, Li Y, Lei F, Chen W, Arbing R
BMC Cancer. 2024; 24(1):613.
PMID: 38773461
PMC: 11107036.
DOI: 10.1186/s12885-024-12360-0.
Patient preferences for prophylactic regimens requiring regular injections in children and adolescents: a systematic review and thematic analysis.
Ilievski J, Mirams O, Trowman R, Barr R, Manning L
BMJ Paediatr Open. 2024; 8(1).
PMID: 38769047
PMC: 11110590.
DOI: 10.1136/bmjpo-2023-002450.
Shared decision-making with athletes: a survey study of healthcare professionals' perspectives.
Nelis S, Dijkstra H, Damman O, Farooq A, Verhagen E
BMJ Open Sport Exerc Med. 2024; 10(2):e001913.
PMID: 38736642
PMC: 11086382.
DOI: 10.1136/bmjsem-2024-001913.
Development of a patient decision aid for children and adolescents following anterior cruciate ligament rupture: an international mixed-methods study.
Gamble A, McKay M, Anderson D, Pappas E, Cooper I, Macpherson S
BMJ Open. 2024; 14(4):e081421.
PMID: 38684251
PMC: 11086191.
DOI: 10.1136/bmjopen-2023-081421.
Barriers and facilitators to parent-delivered interventions for children with or infants at risk of cerebral palsy. An integrative review informed by behaviour change theory.
Massey J, Harniess P, Chinn D, Robert G
Disabil Rehabil. 2024; 47(2):287-301.
PMID: 38627931
PMC: 11716669.
DOI: 10.1080/09638288.2024.2338193.