Limitations
This study has several limitations. First, the hypothetical case used
may not accurately reflect physician attitudes and action in clinical
practice. Second, survey questions are open to respondent
interpretation, and the limited qualitative data limits interpretation.
Third, the study format risks selection bias based on survey completion,
although the response rate of 69% is acceptable. Fourth, the sample
size of physicians was small and restricted to a single center. This
resulting in the inability to detect many significant effects, despite
suggestion of several trends, significantly limiting the findings and
the generalizability. Fifth, the study was very limited in scope. It
evaluated only one chronic disease, and only one clinical scenario
within this. As a result, the broader implications outside of CF and
chronic illness in general, are not entirely clear. Lastly, this study
only evaluated physician beliefs towards pediatric shared
decision-making, and did not address the views of pediatric patients or
their parents. Nonetheless, it is an important first step in identifying
physician barriers towards involving children with chronic disease in
decision-making, and it may be applicable to many other populations.