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.