title: Shared Decision Making in Pediatrics: A Systematic Review and Meta-analysis.
abstract: BACKGROUND
  Little is known about the impact of interventions to support shared decision making (SDM) with pediatric patients.
  
  
  OBJECTIVE
  To summarize the efficacy of SDM interventions in pediatrics on patient-centered outcomes.
  
  
  METHODS
  We searched Ovid Medline, Ovid Embase, Ovid Cochrane Library, Web of Science, Scopus, and Ovid PsycInfo from database inception to December 30, 2013, and performed an environmental scan.
  
  
  METHODS
  We included interventions designed to engage pediatric patients, parents, or both in a medical decision, regardless of study design or reported outcomes.
  
  
  METHODS
  We reviewed all studies in duplicate for inclusion, data extraction, and risk of bias assessment. Meta-analysis was performed on 3 outcomes: knowledge, decisional conflict, and satisfaction.
  
  
  RESULTS
  Sixty-one citations describing 54 interventions met eligibility criteria. Fifteen studies reported outcomes such that they were eligible for inclusion in meta-analysis. Heterogeneity across studies was high. Meta-analysis revealed SDM interventions significantly improved knowledge (standardized mean difference [SMD] 1.21, 95% confidence interval [CI] 0.26 to 2.17, P = .01) and reduced decisional conflict (SMD -1.20, 95% CI -2.01 to -0.40, P = .003). Interventions showed a nonsignificant trend toward increased satisfaction (SMD 0.37, 95% CI -0.04 to 0.78, P = .08).
  
  
  CONCLUSIONS
  Included studies were heterogeneous in nature, including their conceptions of SDM.
  
  
  CONCLUSIONS
  A limited evidence base suggests that pediatric SDM interventions improve knowledge and decisional conflict, but their impact on other outcomes is unclear.
  PROSPERO CRD42013004761 (http://www.crd.york.ac.uk/PROSPERO/display_record.asp?ID=CRD42013004761).
authors.affiliation: Pediatric and Adolescent Medicine Residency Program, Mayo School of Graduate Medical Education, Mayo Clinic, Rochester, Minn; Mayo Medical School, Mayo Clinic, Rochester, Minn; Knowledge and Evaluation Research Unit, Mayo Clinic, Rochester, Minn.
authors.forename: Kirk D
authors.initials: KD
authors.lastname: Wyatt
authors.affiliation: James M. Anderson Center for Health Systems Excellence, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio.
authors.forename: Betsy
authors.initials: B
authors.lastname: List
authors.affiliation: Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio.
authors.forename: William B
authors.initials: WB
authors.lastname: Brinkman
authors.affiliation: Knowledge and Evaluation Research Unit, Mayo Clinic, Rochester, Minn; Unidad de Conocimiento y Evidencia, Universidad Peruana Cayetano Heredia, Lima, Peru; Department of Pediatrics, Children's Hospital of Michigan, Wayne State University School of Medicine/Detroit Medical Center, Detroit, Mich.
authors.forename: Gabriela
authors.initials: G
authors.lastname: Prutsky Lopez
authors.affiliation: Knowledge and Evaluation Research Unit, Mayo Clinic, Rochester, Minn.
authors.forename: Noor
authors.initials: N
authors.lastname: Asi
authors.affiliation: Mayo Clinic Libraries, Mayo Clinic, Rochester, Minn.
authors.forename: Patricia
authors.initials: P
authors.lastname: Erwin
authors.affiliation: Knowledge and Evaluation Research Unit, Mayo Clinic, Rochester, Minn.
authors.forename: Zhen
authors.initials: Z
authors.lastname: Wang
authors.affiliation: Knowledge and Evaluation Research Unit, Mayo Clinic, Rochester, Minn; Unidad de Conocimiento y Evidencia, Universidad Peruana Cayetano Heredia, Lima, Peru; Department of Internal Medicine, Henry Ford Hospital, Detroit, Mich.
authors.forename: Juan Pablo
authors.initials: JP
authors.lastname: Domecq Garces
authors.affiliation: Knowledge and Evaluation Research Unit, Mayo Clinic, Rochester, Minn; Division of Endocrinology, Diabetes, Metabolism, and Nutrition, Mayo Clinic, Rochester, Minn; Department of Health Sciences Research, Division of Health Care Policy and Research, Mayo Clinic, Rochester, Minn.
authors.forename: Victor M
authors.initials: VM
authors.lastname: Montori
authors.affiliation: Knowledge and Evaluation Research Unit, Mayo Clinic, Rochester, Minn; Department of Health Sciences Research, Division of Health Care Policy and Research, Mayo Clinic, Rochester, Minn. Electronic address: LeBlanc.Annie@mayo.edu.
authors.forename: Annie
authors.initials: A
authors.lastname: LeBlanc
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D003657:Decision Making; D003661:Decision Support Techniques; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D010358:Patient Participation; D010372:Pediatrics; D010817:Physician-Patient Relations; D011368:Professional-Family Relations
keywords: adolescent; child; child, preschool; decision aids; decision making; decision making, shared; decision support techniques; infant; infant, newborn; pediatrics