Collaborative decision-making and promoting treatment adherence in pediatric chronic illness

Collaborative or shared decision-making between health care providers and families can facilitate treatment adherence, health outcomes, and satisfaction with care in the management of pediatric chronic illness, but raises special challenges. Barriers such as authoritarian models of medical care as well as absence of time and opportunity for dialogue limit collaborative decision making and can disrupt treatment adherence. However, models of provider-family communication that emphasize communication and shared goal-setting inform an anticipatory guidance model of collaborative decision-making that can enhance treatment adherence. Salient challenges and strategies involved in implementing collaborative decision-making in pediatric chronic illness care are described. Research is needed to: 1) describe the communication and decision-making process in the management of pediatric chronic illness; and 2) evaluate the impact of interven- tions that enhance collaborative decision-making on provider-family communication, illness management, and treatment adherence.