The Promise of Shared Decision-making in Pediatrics
On one end of the spectrum of decision-making in medicine is paternalism, in which the clinician formulates and communicates the treatment plan to the family. At the other end is informed choice, in which the family decides after gathering information from the clinician or other sources. Situated between these extremes, shared decision-making (SDM) involves the clinician explaining the medical evidence for different options and family members discussing these options in the context of their personal values. With both the medical evidence and personal values delineated, the clinician and family jointly determine the treatment plan. SDM is especially helpful for clinical situations with multiple evidence-based options and when variation exists in how families weigh their risks and benefits.