title: Children's participation in shared decision-making: children, adolescents, parents and healthcare professionals' perspectives and experiences.
abstract: OBJECTIVE
  Despite decision-making featuring throughout the trajectory of cancer care, children's participation in decision-making remains an area much under-researched and complicated by conflicting opinions. This study explored children's participation in shared decision-making (SDM) from multiple perspectives from one haematology/oncology unit in Ireland.
  
  
  METHODS
  Qualitative research design was used to explore participants' experiences of children's decision-making. Interviews were conducted with children(1) aged 7-16 years (n = 20), their parents (n = 22) and healthcare professionals (n = 40). Data were managed with the aid of NVivo (version 8).
  
  
  RESULTS
  Parents and children's roles in decision-making were significantly influenced by the seriousness of the illness. Cancer is a life-threatening illness and so the treatment 'had to be done'. Children were not involved in major decisions (treatment decisions) as refusal was not an option. They were generally involved in minor decisions (choices about care delivery) with the purpose of gaining their cooperation, making treatment more palatable, giving back a sense of control and building trusting relationships. These choices were termed 'small' decisions that would not compromise the child's welfare. Some adolescents were aware that choices were not 'real' decisions since they were not allowed to refuse and expressed feelings of frustration.
  
  
  CONCLUSIONS
  Healthcare professionals and parents controlled the process of SDM and the children's accounts revealed that they held a minimal role. Children appeared content that adults held responsibility for the major treatment decisions. However, they desired and valued receiving information, voicing their preferences and choosing how treatments were administered to them.
authors.affiliation: School of Nursing and Midwifery, Trinity College Dublin, 24 D'Olier Street, Dublin 2, Ireland. Electronic address: coynei@tcd.ie.
authors.forename: Imelda
authors.initials: I
authors.lastname: Coyne
authors.affiliation: School of Nursing and Midwifery, Trinity College Dublin, 24 D'Olier Street, Dublin 2, Ireland. Electronic address: aislinna@gmail.com.
authors.forename: Aislinn
authors.initials: A
authors.lastname: Amory
authors.affiliation: School of Nursing, Dublin City University, Glasnevin, Dublin 9, Ireland. Electronic address: gemma.kiernan@dcu.ie.
authors.forename: Gemma
authors.initials: G
authors.lastname: Kiernan
authors.affiliation: Faculty of Health and Social Care, Department of Children's Nursing, London South Bank University, 103 Borough Road, London SE1 OAA, UK. Electronic address: faith.gibson@lsbu.ac.uk.
authors.forename: Faith
authors.initials: F
authors.lastname: Gibson
mesh_terms: D000293:Adolescent; D000328:Adult; D002648:Child; D003657:Decision Making; D005260:Female; D006801:Humans; D007494:Ireland; D008297:Male; D009369:Neoplasms / Q000523:psychology*; D010287:Parent-Child Relations; D010290:Parents / Q000523:psychology; D010358:Patient Participation / Q000523:psychology*; D011369:Professional-Patient Relations; D036301:Qualitative Research
keywords: Cancer; Children; Healthcare professionals; Information; Interactions; Parent; Participation; Qualitative; Shared decision-making