Center for Biomedical Ethics and Law, Department of Public Health and Primary Care, KU Leuven, Leuven, Belgium.
Department of Development and Regeneration, Leuven, Belgium.
Eur J Pediatr. 2024 Oct;183(10):4195-4203. doi: 10.1007/s00431-024-05687-0. Epub 2024 Aug 21.
Adolescence is a period of growing independence and maturity, within the period of legal minority. As parents or guardians are socially and legally responsible for adolescents' medical decisions, shared decision-making in adolescent healthcare could be ethically challenging. This review aims to identify and map the ethical tensions in shared decision-making in adolescent healthcare.
We systematically searched the literature following the PRISMA guidelines to identify relevant articles, which were analyzed using the review of reasons methodology Strech and Sofaer (J Med Ethics 38(2):121-6, 2012).
We included 38 articles which involved adolescents, healthcare professionals and parents as being the main stakeholders. Shared decision-making was influenced not only by individual stakeholders' characteristics, but by tensions between stakeholder dyads. Most studies supported the involvement of the adolescent in decision-making, depending on their life experience, decision-making capacity and clinical condition.
Shared decision-making in adolescent health is receiving increasing attention. However, questions remain on what this concept entails, the roles and involvement of stakeholders and its practical implementation.
• Although adolescents wish to be involved in health decisions, shared decision-making in adolescents is underexplored • Adolescent shared decision-making is different from pediatric and adult shared decision-making, and is ethically complex due to the adolescent's growing autonomy What is new: • Adolescent SDM involves three-way interactions between the adolescent, healthcare professional and parents • In adolescent shared decision-making, involving or excluding a stakeholder and sharing or withholding information are ethically value-laden steps • Research is needed to further understand the roles of adolescents' personal value systems, extended or reconstituted families and decision aids in shared decision-making.
青春期是一个逐渐独立和成熟的时期，也是法律意义上的未成年人阶段。由于父母或监护人在社会和法律上对青少年的医疗决策负责，因此在青少年医疗保健中进行共同决策可能在伦理上具有挑战性。本综述旨在确定和描绘青少年医疗保健中共同决策的伦理紧张局势。
我们按照 PRISMA 指南系统地搜索文献，以确定相关文章，并使用 Strech 和 Sofaer（J Med Ethics 38(2):121-6, 2012）的原因综述方法对其进行分析。
我们纳入了 38 篇文章，这些文章涉及青少年、医疗保健专业人员和父母作为主要利益相关者。共同决策不仅受到各利益相关者特征的影响，还受到利益相关者对偶之间的紧张关系的影响。大多数研究都支持青少年根据自己的生活经验、决策能力和临床状况参与决策。
青少年健康的共同决策越来越受到关注。然而，关于这一概念的含义、利益相关者的角色和参与以及其实践实施仍存在疑问。
尽管青少年希望参与健康决策，但青少年的共同决策仍未得到充分探索。
青少年共同决策与儿科和成人共同决策不同，由于青少年的自主权不断增强，因此在伦理上较为复杂。
青少年 SDM 涉及青少年、医疗保健专业人员和父母之间的三方互动。
在青少年共同决策中，涉及或排除利益相关者以及共享或隐瞒信息是具有伦理价值的步骤。
需要进一步研究以更好地理解青少年个人价值体系、扩展或重组家庭以及决策辅助工具在共同决策中的作用。
