title: What is known about parents' treatment decisions? A narrative review of pediatric decision making.
abstract: With the increasing complexity of decisions in pediatric medicine, there is a growing need to understand the pediatric decision-making process.
  
  
  
  To conduct a narrative review of the current research on parent decision making about pediatric treatments and identify areas in need of further investigation.
  
  
  
  Articles presenting original research on parent decision making were identified from MEDLINE (1966-6/2011), using the terms "decision making," "parent," and "child." We included papers focused on treatment decisions but excluded those focused on information disclosure to children, vaccination, and research participation decisions.
  
  
  
  We found 55 papers describing 52 distinct studies, the majority being descriptive, qualitative studies of the decision-making process, with very limited assessment of decision outcomes. Although parents' preferences for degree of participation in pediatric decision making vary, most are interested in sharing the decision with the provider. In addition to the provider, parents are influenced in their decision making by changes in their child's health status, other community members, prior knowledge, and personal factors, such as emotions and faith. Parents struggle to balance these influences as well as to know when to include their child in decision making.
  
  
  
  Current research demonstrates a diversity of influences on parent decision making and parent decision preferences; however, little is known about decision outcomes or interventions to improve outcomes. Further investigation, using prospective methods, is needed in order to understand how to support parents through the difficult treatment decisions.
authors.affiliation: Division of Adolescent Medicine (EAL, MTB) Cincinnati Children’s Hospital Medical Center, Cincinnati, OH|Center for Innovation in Chronic Disease Care (EAL, WBB, MTB) Cincinnati Children’s Hospital Medical Center, Cincinnati, OH|University of Cincinnati College of Medicine, Cincinnati, OH (EAL, WBB, MTB)
authors.forename: Ellen A
authors.initials: EA
authors.lastname: Lipstein
authors.affiliation: Center for Innovation in Chronic Disease Care (EAL, WBB, MTB) Cincinnati Children’s Hospital Medical Center, Cincinnati, OH|Division of General and Community Pediatrics (WBB) Cincinnati Children’s Hospital Medical Center, Cincinnati, OH|University of Cincinnati College of Medicine, Cincinnati, OH (EAL, WBB, MTB)
authors.forename: William B
authors.initials: WB
authors.lastname: Brinkman
authors.affiliation: Division of Adolescent Medicine (EAL, MTB) Cincinnati Children’s Hospital Medical Center, Cincinnati, OH|Center for Innovation in Chronic Disease Care (EAL, WBB, MTB) Cincinnati Children’s Hospital Medical Center, Cincinnati, OH|Anderson Center for Health Systems Excellence (MTB) Cincinnati Children’s Hospital Medical Center, Cincinnati, OH|University of Cincinnati College of Medicine, Cincinnati, OH (EAL, WBB, MTB)
authors.forename: Maria T
authors.initials: MT
authors.lastname: Britto
mesh_terms: D002648:Child; D002755:Choice Behavior; D003256:Community Participation; D003258:Consumer Behavior; D003657:Decision Making; D006304:Health Status; D006801:Humans; D033262:Narration; D010043:Outcome and Process Assessment, Health Care; D010290:Parents / Q000193:education / Q000523:psychology*; D011446:Prospective Studies; D012106:Research