Qualitative Responses
The final survey question asked the respondent to describe his or her responses to the scenarios. Thirteen physicians (65%) completed this. There were a few common themes that emerged. First, respondent’s viewpoints were often guided by legal age-related constraints. Second, there was a tension between the legal decision-making authority and a desire to grant the child decision-making capacity in certain contexts. Third, many viewed their position as one of reconciling between the various stakeholders and attempting to come to an agreement. The following excerpts from respondents illustrate these themes:
“The age of majority is 18 - regardless of ”who is the major decision maker, parents or children” legally the parents have the final say until age 18.”“I believe in all of the scenarios that currently the parents are the final decision makers based upon age. However, my opinion is that regardless of age, if Anna understands the components of the procedure, is able to describe the risks/benefits and is involved in her own care, that she should be eligible to make her own decisions. Although legally she is still a minor, I believe the criteria listed above would demonstrate understanding of the procedure and should allow for her to give informed consent regarding her medical decision making.”“Rather, my role in shared decision making is to try to help them have the opportunity to share their thoughts and feelings, find common ground, and determine the best course of action for the patient given their goals.”
These common themes highlight many of the challenges of implementing pediatric SDM.