Optimizing Children's Involvement in Decision Making Requires Moving Beyond the Concept of Ability.
Optimizing Children's Involvement in Decision Making Requires Moving Beyond the Concept of Ability.
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DOI：
10.1080/15265161.2017.1418923
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发表时间：
2018-03
期刊：
影响因子：
--
通讯作者：
Miller VA
中科院分区：
文献类型：
--
作者：
Miller VA
In the target article,“The Default Position: Optimizing Pediatric Participation in Medical Decision Making,” Olszewski and Goldkind (2018) present an important argument concerning involving children in medical decision making. The authors argue that children should routinely be given a voice and describe a stepwise approach to determining when and how a child should be involved. Their framework is informed by the regulatory requirements for research assent, case studies of adolescent refusal of clinical care, and guidelines for involvement of adults with impaired decisional capacity. They describe their application of this approach to two clinical cases, a 15-year-old with a malignant facial tumor and a 7-year-old with incurable metastatic rhabdomyosarcoma. I commend the authors for outlining a framework for involving children and adolescents in decision making, especially because their framework assumes that children can almost always be involved. Involving children shows respect for their developing autonomy and may have additional benefits, discussed more in the following. Olszewski and Goldkind cogently underscore the complex dynamics of supporting both parents and children in a fluid and continual process of decision making. Importantly, they recognize that developmental factors and aspects of the environment will influence children’s participation, as well as the child’s interest in participating. Olszewski and Goldkind move the literature forward by describing, in their Table 1, factors to consider when assessing when and how to involve a child in medical decision making. However, the authors do not go far enough in emphasizing that there are multiple ways for children to be involved in decision making, even if they do not have the final say. The concept of decision-making involvement refers to ways that children can be involved in decisions and includes active verbal participation and adult attempts to involve the child (Miller and Harris 2012). For example, children can be asked for their opinions, concerns, or questions related to a decision, they can be told that they have an important role to play and that adults care about what they think, they can be assessed for their understanding of the situation and/or aspects of the decision, or, as the authors note, they can be given choices related to the decision that will be implemented. Even very young children can be asked how they feel about a decision or if they understand certain elements of a decision, even if it is clear that parents will make the final decision. The authors’ assertion that the child’s wishes will not be sought in the case of a low-risk, lifesaving therapy is a narrow view, because it does not recognize that the child can be involved in different ways and that such involvement may have important benefits. These include increasing the child’s sense of control and self-efficacy, enhancing adherence to the implemented decision, and teaching the child how to communicate about and make decisions. Unfortunately, there is a dearth of prior research for the authors to draw on, because the field has been limited by a lack of measures for assessing children’s involvement in decision making. However, in my recent work, I developed a measure of decision-making involvement to assess parent–child interactions about decisions having to do with chronic illness management, called the Decision Making Involvement Scale (DMIS)(Miller and Harris 2012). Research using that measure found that youths’ active involvement and joint decision-making behaviors during decision making interactions with parents were associated with better adherence in youth with type 1 diabetes (Miller and Jawad …
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影响因子：
2.2
作者：
Miller, Victoria A.;Jawad, Abbas F.
通讯作者：
Jawad, Abbas F.
影响因子：
3.6
作者：
Miller, Victoria A.;Harris, Diana
通讯作者：
Harris, Diana
影响因子：
1.3
作者：
Miller, Victoria A.
通讯作者：
Miller, Victoria A.
影响因子：
13.4
作者：
Olszewski, Aleksandra E.;Goldkind, Sara F.
通讯作者：
Goldkind, Sara F.
影响因子：
2.4
作者：
Ruhe, Katharina M.;De Clercq, Eva;Elger, Bernice S.
通讯作者：
Elger, Bernice S.