Discussion of alternatives, risks and benefits in pediatric acute care

OBJECTIVE: Across adult healthcare, discussions of alternatives, risks and benefits vary in inclusiveness or are even absent. We examine these discussions and their associated factors in pediatric visits. METHODS: Coders noted speaker and recipient for alternatives, risks and benefits from 98 videotaped visits. Outcomes included discussion of alternatives, risks or benefits (yes/no) and involvement of parent or child in discussions (active or passive). Bivariate techniques were used to relate visit factors to outcomes. RESULTS: Most visits included discussion of alternatives (58% of visits), risks (54%) and benefits (69%). Longer visits were more likely to include risk discussions. For alternatives, active parent/child involvement was more likely with college graduate parents; for risks active involvement was more likely with female and more experienced physicians. Parents and children raised risks more frequently than benefits, often focusing on disadvantages such as taste or frequency/duration of therapy. CONCLUSION: Most pediatric visits include alternatives, risks and benefits but parent/child involvement in raising these topics is limited. PRACTICE IMPLICATIONS: When parents or children initiate these discussions, they often mention risks salient to adherence. Future work could explore whether longer visits or interventions targeted for specific participants could foster such discussions.