Evaluation of Shared Decision-Making Interventions in Pediatric Acute Care: A Systematic Review
Bibliographic record
Abstract
CONTEXT: There is limited consensus on the effectiveness of shared decision-making (SDM) interventions in pediatric acute care, where implementing SDM is particularly challenging. OBJECTIVE: To conduct a systematic review on the effectiveness of SDM interventions in pediatric acute care settings (PROSPERO: CRD42023394760). DATA SOURCES: MEDLINE, EMBASE, Cochrane Library, CINAHL, Web of Science, Scopus, and PsycInfo databases from inception to November 12, 2024. STUDY SELECTION: Studies that evaluated SDM intervention effectiveness for managing acute medical problems-those requiring an urgent or time-sensitive decision at the current clinical visit-in children and youth (aged <19 years). DATA EXTRACTION: Data were extracted on study participants, study design, clinical decision assessed, and patient-centered and clinical outcomes evaluated. RESULTS: Of 10 278 articles identified, 27 studies were included. These studies focused on acute respiratory infection (n = 5), intensive care unit decision (n = 5), head injury (n = 4), appendicitis (n = 4), febrile infant (n = 3), and other care decisions (n = 6). A breadth of outcome measures and measurement tools were used. In general, SDM interventions had positive impacts on patient-centered and clinical outcomes and were not accompanied by increased resource use, repeat health care utilization, or complications. LIMITATIONS: Heterogeneity in SDM interventions and outcome measures limited the ability to conduct meta-analyses on intervention effectiveness. CONCLUSIONS: SDM interventions have been evaluated in several pediatric acute care settings. Across a range of studies, SDM interventions were observed to improve patient-centered outcomes without increasing complications. Additional research using standardized outcome measurements is needed.
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How this classification was reachedexpand
Full frame distilled prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. Learned from the 10,348 direct Codex labels and 10,348 direct Gemma labels. Candidate is the union of thresholded teacher heads; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels or direct frontier model labels.
Codex and Gemma teacher scores by category
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.004 | 0.031 |
| Meta-epidemiology (narrow) | 0.001 | 0.001 |
| Meta-epidemiology (broad) | 0.004 | 0.001 |
| Bibliometrics | 0.002 | 0.005 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.002 | 0.001 |
| Research integrity | 0.001 | 0.002 |
| Insufficient payload (model declined to judge) | 0.000 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one teacher head, not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".