Decision-making capacity of children and adolescents—suggestions for advancing the concept’s implementation in pediatric healthcare

Abstract

A detailed understanding of DMC is necessary to inform developmentally appropriate participation. In order to achieve this, pediatric practice needs to address challenges that are specific to providing healthcare for children, including conceptual issues, assessment, and aspects of child development.

Conflict in a paediatric hospital: a prospective mixed-method study

“…Severity scores were designated into three groups: low (1-3), moderate (4-7) and high (8)(9)(10). Thirty-six per cent of all incidents were rated as low, 47% were rated as moderate and 17% were rated as high.…”

“…So, for example, you can have families who take an hour of the ward round time every day and then another member of the family comes in and you have to go through the whole thing again and lots and lots of explaining, lots and lots of questioning about why things are being done, child gets the treatment, everything eventually moves forward, but it is extremely demanding. (Consultant) A score of 8-10 would necessitate security staff to keep staff safe and the patient ceasing to be the focus of conversations: 8,9 or 10, I would consider to be when I call security. So, violence and aggression, physical aggression.…”

“…6 In end-of-life decision-making for children, the majority of relatives report that the decision to withdraw care should be made jointly between clinicians and families, 7 with a small number believing the decision lies solely with the families. 8 The input the child has into the decision-making process depends upon the individual's level of maturity as assessed by the clinician. 9 Limited work has been conducted outside of the ICU context examining the incidence and severity of conflict in paediatric settings, though some papers offer reflexive accounts from practitioners around conflict, 10 case reviews and court reports, 11 tracing the history of care standards over treatment decision-making over time 12 and mapping how conflict escalates.…”

Goal formulation and tracking in child mental health settings: when is it more likely and is it associated with satisfaction with care?

“…There are a number of barriers to formulating and tracking goals in child mental health practice, including the child’s capacity to do so [29, 64]; involvement of parents who may have different experiences and perceptions to the child or their own emotional and behavioural difficulties [75]; lack of resources to record goals formally (or the pressure to do so) and training on setting and tracking meaningful goals [34, 61]; and safeguarding concerns around balancing the involvement of the child with their vulnerability [2, 71]. Some models of therapy (e.g.…”

Adolescents and Their Parents Differ on Descriptions of a Reproductive Health Study

“…Their descriptions may reflect salient aspects which, in turn, may impact study recruitment, final decision-making regarding participation, and/or retention. 17,18,19 Understanding what information about studies adolescents/parents might share with their peers in the community may provide insight regarding the use of snowball sampling (where an individual is referred into the study by a current study participant), respondent-driven sampling (or chain-referral sampling with good estimability to compensate for any non-random selection often used when accessing hard-to-reach populations), or community advisory boards (using representatives of the general public to advise representatives of an institution about research recruitment and/or design). 20,21,22 …”