Communication strategies and persuasion as core components of shared decision-making for children with life-limiting conditions: A multiple case study

Popejoy, Emma; Almack, Kathryn; Manning, Joseph C; Johnston, Bridget; Pollock, Kristian

Abstract

Background
Families and professionals caring for children with life-limiting conditions face difficult healthcare decisions. Shared decision-making is promoted in many countries, however little is known about factors influencing these processes.

Aim
To explore the communication strategies used in shared decision-making for children with life-limiting conditions.

Design
A longitudinal, qualitative, multiple-case study. Cases were centred around the child and parent/carer(s). Most cases also included professionals or extended family members. Data from interviews, observations and medical notes were re-storied for each case into a narrative case summary. These were subject to comparative thematic analysis using NVivo11.

Setting/participants
Eleven cases recruited from three tertiary hospitals in England. 23 participants were interviewed (46 interviews). Cases were followed for up to 12 months between December 2015 and January 2017. 72 observations were conducted and the medical notes of 9 children reviewed.

Findings
Strategies present during shared decision-making were underpinned by moral work. Professionals presented options they believed were in the child’s best interests, emphasising their preference. Options were often presented in advance of being necessary to prevent harm, therefore professionals permitted delay to treatment. Persuasion was utilised over time when professionals felt the treatment was becoming more urgent and when families felt it would not promote the child’s psychosocial wellbeing.

Conclusions
Communication strategies in shared decision-making are underpinned by moral work. Professionals should be aware of the models of shared decision-making which include such communication strategies. Open discussions regarding individuals’ moral reasoning may assist the process of shared decision-making.

Citation

Popejoy, E., Almack, K., Manning, J. C., Johnston, B., & Pollock, K. (2022). Communication strategies and persuasion as core components of shared decision-making for children with life-limiting conditions: A multiple case study. Palliative Medicine, 36(3), 519-528. https://doi.org/10.1177/02692163211068997

• Journal Article Type: Article
• Acceptance Date: Dec 7, 2021
• Online Publication Date: Dec 30, 2021
• Publication Date: Mar 1, 2022
• Deposit Date: Dec 14, 2021
• Publicly Available Date: Dec 30, 2021
• Journal: Palliative Medicine
• Electronic ISSN: 1477-030X
• Publisher: SAGE Publications
• Peer Reviewed: Peer Reviewed
• Volume: 36
• Issue: 3
• Pages: 519-528
• DOI: https://doi.org/10.1177/02692163211068997
• Keywords: Anesthesiology and Pain Medicine; General Medicine
• Public URL: https://nottingham-repository.worktribe.com/output/7016353
• Publisher URL: https://journals.sagepub.com/doi/full/10.1177/02692163211068997