Navigating Decisional Discord: The Pediatrician's Role When Child and Parents Disagree
Navigating Decisional Discord: The Pediatrician's Role When Child and Parents Disagree
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DOI：
10.1542/peds.2017-0234
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发表时间：
2017-06-01
期刊：
影响因子：
8
通讯作者：
Feudtner, Chris
中科院分区：
文献类型：
--
作者：
Sisk, Bryan A.;DuBois, James;Feudtner, Chris
从儿童进入青春期前开始，儿科医疗决策可能需要儿童，父母和儿科医生之间的复杂互动。当孩子和父母对医疗决定意见不一致时，儿科医生就面临着指导家庭做出最终决定的挑战。未解决的不和会影响家庭凝聚力、患者依从性和患者自我管理。在这篇文章中，我们概述了3种模式的儿科医生的作用，在设置的决定不一致：服从，倡导和仲裁。在顺从模型中，儿科医生优先考虑父母的决策权。在倡导模式中，只要孩子的决定在医学上是合理的，儿科医生就主张孩子在决策中的偏好。在仲裁模式中，儿科医生以平衡的方式解决冲突。虽然每种模式都有其优缺点，但仲裁模式应作为几乎所有环境中的初始模式。仲裁模式很可能通过尊重父母的权威和儿童自主性的发展，以维持家庭凝聚力的方式做出最有益的决定。然而，我们也强调，当顺从或倡导模式可能更合适的场合。医生应该在他们的专业工具包中保留所有3种模型，并开发智慧来为每个特定的临床情况部署正确的模型。
From the time when children enter the preteen years onward, pediatric medical decision-making can entail a complex interaction between child, parents, and pediatrician. When the child and parents disagree regarding medical decisions, the pediatrician has the challenging task of guiding the family to a final decision. Unresolved discord can affect family cohesiveness, patient adherence, and patient self-management. In this article, we outline 3 models for the pediatrician's role in the setting of decisional discord: deference, advocative, and arbitrative. In the deference model, the pediatrician prioritizes parental decision-making authority. In the advocative model, the pediatrician advocates for the child's preference in decision-making so long as the child's decision is medically reasonable. In the arbitrative model, the pediatrician works to resolve the conflict in a balanced fashion. Although each model has advantages and disadvantages, the arbitrative model should serve as the initial model in nearly all settings. The arbitrative model is likely to reach the most beneficial decision in a manner that maintains family cohesiveness by respecting the authority of parents and the developing autonomy of children. We also highlight, however, occasions when the deference or advocative models may be more appropriate. Physicians should keep all 3 models available in their professional toolkit and develop the wisdom to deploy the right model for each particular clinical situation.