Shared decision-making and assent in children — formative SAQs

SAQ 1 — Preference-sensitive imaging decision (10 marks)

A well-appearing 5-year-old presents after a minor head injury. There is no indication for immediate imaging on clinical rules. The parent is anxious and asks "can't you just scan him to be sure?" ^{[9] [11]}

Questions

1. Frame this encounter using the three-talk model of shared decision-making. (4 marks) ^[4]
2. What is the role and evidence base for a decision aid here? (3 marks) ^{[9] [11]}
3. How do you seek the child's assent and document the encounter? (3 marks) ^{[1] [10]}

Model answer

Three-talk framing (4). Team talk: name that a decision point has arrived (observe at home versus CT), and offer a partnership role. Option talk: present the reasonable options with benefits, harms and uncertainties — observation avoids radiation and is safe given low pre-test probability, while CT gives certainty but carries a small radiation burden and occasional incidental findings. Decision talk: elicit what the family values most (reassurance now versus avoiding radiation), check understanding with teach-back, and agree a choice. ^[4]

Decision aid role and evidence (3). A validated head CT choice decision aid structures options and harms. In a cluster-randomised trial it reduced CT use without an increase in missed clinically important injuries, and it reached potentially vulnerable parents. The aid supports but does not replace the values conversation. ^{[9] [11]}

Assent and documentation (3). Seek developmentally appropriate assent from the 5-year-old using simple language about what observation means and what would bring them back. Record the options discussed, the values that drove the choice, the child's view, and a concrete safety-net and review plan. ^{[1] [10]}