Navigating decisional discord: The pediatrician's role when child and parents disagree

Bryan A. Sisk, James DuBois, Eric Kodish, Joanne Wolfe, Chris Feudtner

Research output: Contribution to journalArticlepeer-review

9 Scopus citations

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.

Original languageEnglish
Article numbere20170234
JournalPediatrics
Volume139
Issue number6
DOIs
StatePublished - Jun 2017

Fingerprint Dive into the research topics of 'Navigating decisional discord: The pediatrician's role when child and parents disagree'. Together they form a unique fingerprint.

Cite this