A Learning Loop Model of Collaborative Decision-Making in Chronic Illness |
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Authors: | Sarah D. Ronis Lawrence C. Kleinman Kurt C. Stange |
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Affiliation: | 1. Department of Pediatrics, Case Western Reserve University, and UH Rainbow Center for Child Health and Policy, UH Rainbow Babies and Children''s Hospital, Cleveland, Ohio (SD Ronis);2. Department of Pediatrics, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ (LC Kleinman);3. Center for Community Health Integration, Department of Family Medicine & Community Health, Department of Population & Quantitative Health Sciences, Department of Sociology, Case Western Reserve University, Cleveland, Ohio (KC Stange) |
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Abstract: | Shared decision-making is a core attribute of quality health care that has proved challenging to implement and assess in pediatric practice. Current models of shared decision-making are limited, including their capacity to incorporate multiple stakeholders; to integrate downstream effects of subacute or minor decisions; and to account for the context(s) in which such decisions are being made and enacted. Based on a review of literature from organizational psychology, cognitive sciences, business, and medicine, we propose an iterative decision-making model of care planning and identify targets at several levels of influence warranting measurement in future studies. Our learning loop model posits the relationship between pediatric patients, their parents, and their clinicians as central to the collaborative decision-making process in the setting of chronic illness. The model incorporates the evolution of both context and developmental capacity over time. It suggests that “meta-learning” from the experience of and outcomes from iterative decision is a key factor that may influence relationships and thus continued engagement in collaboration by patients, their parents, and their clinicians. We consider the model in light of the needs of children with special health care needs, for whom understanding the ongoing iterative effects of decision making and clinician?parent?child dynamics are likely to be particularly important in influencing outcomes. |
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Keywords: | Address correspondence to Sarah Ronis, MD, MPH, Department of Pediatrics, UH Rainbow Babies and Children's Hospital, 11100 Euclid Avenue, Mailstop MCCO 6036, Cleveland OH, 44106 care planning children with special health care needs collaborative decision-making doctor?patient relationship family-centered care |
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