Competencies for Pediatric Shared Decision Making: A Delphi Consensus Study

Abstract

Background

Pediatric shared decision making (SDM) involves clinicians working with children and families to make health care decisions that reflect their values and preferences. Existing pediatric SDM programs are highly variable and rely on frameworks designed for adults. While efforts have been made to identify SDM competencies in adult care, this has not happened in pediatrics.

Objective

To establish consensus-based core competencies enabling clinicians to effectively implement SDM with pediatric patients and their families.

Methods

We conducted a modified Delphi study with pediatric clinicians, SDM researchers, ethicists, and medical educators. In round 1, panelists listed essential SDM competencies. In rounds 2 and 3, panelists rated the importance of each competency using a 4-point Likert scale. Consensus was defined as ≥80% of panelists rating an item as “important” or “very important,” a median score ≥3.5, and interquartile range ≤1.

Results

Forty professionals were invited; 22 panelists participated in round 1, suggesting 176 competencies, which were merged with 170 from prior literature. After refinement, 42 competencies were rated in round 2 (n = 21 panelists). During this round, 17 competencies reached consensus, and 8 required modifications. In round 3 (n = 20 panelists), an additional 15 competencies reached consensus. The final framework includes 32 competencies organized into 6 domains: Fundamentals of SDM, Unique Aspects of Pediatric SDM, Communication and Information-Sharing, Eliciting and Integrating Preferences and Values, Collaboration and Consensus Building, and Providing Evidence-Based Recommendations.

Conclusions

This study defines the knowledge, skills, values, and attitudes pediatric health care professionals need to engage children and families in SDM effectively. The framework supports competency-based education and guides curriculum development and assessment to strengthen SDM practice in pediatrics.

Highlights

• This study is the first to develop pediatric-specific SDM competencies using a Delphi approach.

• The final list includes 32 competencies across knowledge, skills, attitudes, and values.

• These competencies provide a foundation for designing SDM training within a competency-based education approach in pediatrics.