Barriers and facilitators to shared decision-making in neonatal medicine: A systematic review and thematic synthesis of parental perceptions |
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| Institution: | 1. Cardiff University, School of Medicine, Cardiff, UK;2. PRIME Centre Wales, School of Medicine, Cardiff, UK;3. Cardiff Metropolitan University, Cardiff School of Sport and Health Sciences, Cardiff, UK;1. Department of Family Medicine, Division of community health, Faculty of health sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel;2. Department of Counseling and Human Development, Haifa University, Israel;1. Division of Hospital Medicine, University of Colorado, 12401 E 17th Avenue, Aurora, CO 80045, USA;2. Division of Hospital Medicine, University of Colorado, Denver Health, Denver, CO, USA;1. Centre for Medical Ethics, University of Oslo, Oslo, Norway;2. Department of Behavioral Sciences in Medicine, University of Oslo, Oslo, Norway;1. Department of Clinical and Health Psychology, University of Florida, Gainesville, FL, USA;2. Department of Psychiatry and Behavioral Sciences, Miller School of Medicine, University of Miami, Miami, FL, USA;3. Wien Center for Alzheimer’s Disease and Memory Disorders, Mount Sinai Medical Center, Miami Beach, FL USA;4. Department of Neurology, University of Florida College of Medicine, Gainesville, FL, USA |
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| Abstract: | ObjectivesSystematically review parental perceptions of shared decision-making (SDM) in neonatology, identifying barriers and facilitators to implementation.MethodsElectronic database (Medline, PsycINFO, CINAHL and Scopus) and follow-up searches were conducted to identify qualitative studies. Data were extracted, thematically analysed and synthesised.ResultsSearches yielded 2445 papers, of which 25 were included. Thematic analysis identified six key themes. Key barriers included emotional crises experienced in the NICU setting, lack of medical information provided to parents to inform decision-making, inadequate communication of information, poor relationships with caregivers, lack of continuity in care, and perceived power imbalances between HCPs and parents. Key facilitators included clear, honest and compassionate communication of medical information, caring and empathetic caregivers, continuity in care, and tailored approaches that reflected parent’s desired level of involvement.ConclusionThe highly specialised environment, and the emotional crises experienced by parents impact significantly on their perceived capacity to engage in surrogate decision-making.Practice ImplicationsComplex and multi-factorial interventions that address the training needs of HCPs, and the emotional, informational and decision support needs of parents are needed. SDM skills training, improved information delivery, and integrated emotional and decisional support could help parents to become more involved in SDM for their infant. |
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| Keywords: | Patient centred care Shared decision making Neonatal medicine Healthcare communication |
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