Treatment decision making

Treatment decision making (TDM) is complex due to the varying decisions which have to be made about diagnosis, treatment options, toxicity, and outcomes of treatment. Shared decision making is complicated by the triadic relationship of parent/caregiver, child and clinician typical in pediatric care. Increasing attention on how best to incorporate child and adolescent and young adult (AYA) voices in decision making is described. We review TDM from the various perspectives of those involved in making decisions about treatment, including parents, children, AYAs, family, and the health care team. Those involved in TDM bring with them their individual characteristics that include values, preferences, past experiences, and cognitive abilities. Interwoven with these influences are the person’s environment, social determinants, and relationships. We incorporate into our discussion the available research literature concluding with what is ready for translation into clinical practice and recommendations for future research to fully understand the varying perspectives and factors which influence TDM and the nurse’s important role in supporting children and their families.