Paeds Cases · professional-practice-and-evidence
Shared decision-making and assent OSCE — imaging choice and chronic-disease disagreement
Observed communication encounter testing shared decision-making, assent, decision-aid use, capacity assessment and management of disagreement with an adolescent.
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Study tools
Target exams
RACP General PaediatricsRACP DCEMRCPCH ClinicalRCPSC Pediatrics
Prompt
Station A is a parent of a well-appearing 5-year-old after minor head trauma requesting a CT scan. Station B is a competent 15-year-old with inflammatory bowel disease disagreeing with her family and team over starting a biologic.
Station objectives
- Diagnose a preference-sensitive decision and run a three-talk shared decision-making conversation. [4]
- Distinguish consent, assent and shared decision-making at the bedside. [1]
- Use a validated decision aid appropriately as a tool, not a substitute for the values conversation. [9] [11]
- Assess an adolescent's decision-specific capacity and manage disagreement constructively. [5]
References8ShowHide
- [1]COMMITTEE ON BIOETHICS Informed Consent in Decision-Making in Pediatric Practice. Pediatrics, 2016.PMID 27456514
- [2]Katz AL Informed Consent in Decision-Making in Pediatric Practice. Pediatrics, 2016.PMID 27456510
- [3]Levetown M Communicating with children and families: from everyday interactions to skill in conveying distressing information. Pediatrics, 2008.PMID 18450887
- [4]Wyatt KD, List B, Brinkman WB, Prutsky Lopez G, Asi N, Erwin P, Wang Z, Domecq Garces JP, Montori VM, LeBlanc A Shared Decision Making in Pediatrics: A Systematic Review and Meta-analysis. Academic pediatrics, 2015.PMID 25983006
- [5]Dodds CM, Britto MT, Denson LA, Lovell DJ, Saeed S, Lipstein EA Physicians' Perceptions of Shared Decision Making in Chronic Disease and Its Barriers and Facilitators. The Journal of pediatrics, 2016.PMID 26817588
- [9]Hess EP, Homme JL, Kharbanda AB, Tzimenatos L Effect of the Head Computed Tomography Choice Decision Aid in Parents of Children With Minor Head Trauma: A Cluster Randomized Trial. JAMA network open, 2018.PMID 30646167
- [10]Quaye AA, Coyne I, Söderbäck M, et al. Children's active participation in decision-making processes during hospitalisation: An observational study. Journal of clinical nursing, 2019.PMID 31430412
- [11]Skains RM, Kuppermann N, Homme JL, Kharbanda AB What is the effect of a decision aid in potentially vulnerable parents? Insights from the head CT choice randomized trial. Health expectations, 2020.PMID 31758633