Improving shared health decision making for children and adolescents with chronic illness: A narrative literature review

This review aims to increase understanding of health decision-making by children and adolescents with chronic illnesses and offer suggestions for improving shared decision-making with healthcare professionals. Methods: Using cross-disciplinary publication databases, we surveyed literature on children's and adolescents’ health decision-making from psychology, health sciences, and neuroscience. Results: Several factors influencing health decision-making were identified. Considering neurobiological aspects, children lack functionality in the frontal lobe resulting in lesser cognitive control and higher risk-taking compared to adults. Additionally, adolescents’ generally higher arousal of socioemotional systems demonstrates neurological underpinnings for reward-seeking behaviours. Psychological investigations of children's health decision-making indicate important age-dependent differences in risk-taking, locus of control, affect and cognitive biases. Furthermore, social influences, particularly from peers, have a large, often negative, effect on individual decision-making due to desire for peer acceptance. Conclusion: Acknowledging these factors is necessary for optimising the process of shared decision-making to support minors with chronic illnesses during healthcare consultations. Practice implications: Doctors and other healthcare professionals may need to counteract some adolescents’ risk-taking behaviours which are often spurred by peer pressure. This can be achieved by highlighting the patient's control over health outcomes, emphasising short-term benefits and long-term consequences of risky behaviours, and recommending peer support networks.