Navigating Decisional Discord: The Pediatrician's Role When Child and Parents Disagree.

TitleNavigating Decisional Discord: The Pediatrician's Role When Child and Parents Disagree.
Publication TypeJournal Article
Year of Publication2017
AuthorsSisk BA, DuBois J, Kodish E, Wolfe J, Feudtner C
JournalPediatrics
Date Published2017 May 12
ISSN1098-4275
Abstract

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.

DOI10.1542/peds.2017-0234
Alternate JournalPediatrics
PubMed ID28562285