Mårtenson Eva K, Fägerskiöld Astrid M
Department of Paediatrics, Ryhov County Hospital, Jönköping, Sweden.
J Clin Nurs. 2008 Dec;17(23):3131-41. doi: 10.1111/j.1365-2702.2006.01920.x. Epub 2007 Nov 14.
The purpose of this literature review was to search for and review, systematically, children's decision-making competence in health care in the scientific literature. Findings of both quantitative and qualitative studies were analysed thematically.
Most previous research in children's decision-making competence in health care concerns adults' care in the best interests of the child. It is important to consider decision-making competence from the child's perspective because of children's own human rights.
Systematic review including database search, manual selection, supplementary searching, management and acquisition of relevant literature, quality appraisal, literature review saturation and thematic review.
Six themes emerged: measurable issues, values and beliefs, power, parent-related communication, trust and self-determination. Measurable issues were age, reading ability and memory. Values and beliefs as well as power and parent-related communication were associated with healthcare professionals. Children showed trust and expressed a wish to use self-determination.
Age appropriate information and participation were prerequisites for allowing children to have possibilities of making competent decisions about their own care. Children's decision-making competence is dependent on others, such as parents and healthcare professionals, attitudes and not only on their own capacity. Lack of competence, however, does not exclude children from the human right to have a say. It should be noted that it is a decision to leave the determination to a parent or healthcare professional.
Future research from the viewpoint of children is important to reach optimal levels of participation, through respecting their integrity and to develop them into potential competent decision makers.
本综述的目的是系统检索并回顾科学文献中儿童在医疗保健方面的决策能力。对定量和定性研究的结果进行了主题分析。
以往关于儿童在医疗保健方面决策能力的大多数研究都关注从儿童最大利益出发的成人护理。由于儿童自身的人权，从儿童的角度考虑决策能力很重要。
系统综述，包括数据库检索、人工筛选、补充检索、相关文献的管理与获取、质量评估、文献综述饱和度和主题综述。
出现了六个主题：可衡量的问题、价值观和信念、权力、与父母相关的沟通、信任和自决。可衡量的问题包括年龄、阅读能力和记忆力。价值观和信念以及权力和与父母相关的沟通与医疗保健专业人员有关。儿童表现出信任并表达了使用自决的愿望。
适合年龄的信息和参与是让儿童有可能就自己的护理做出明智决策的先决条件。儿童的决策能力不仅取决于他们自身的能力，还取决于他人，如父母和医疗保健专业人员的态度。然而，能力不足并不排除儿童拥有发言权的人权。应该注意的是，这是一个将决定权留给父母或医疗保健专业人员的决定。
从儿童的角度进行未来研究对于通过尊重他们的完整性并将他们培养成为潜在的明智决策者来达到最佳参与水平很重要。
