• Melissa Finlay, Vishakha Chakravarti, Francine Buchanan, Tammie Dewan, Sherri Adams, Sanjay Mahant, David Nicholas, Kimberley Widger, Kristina Mangonon McGuire, and Katherine E Nelson.
• Child Health Evaluative Sciences (M.F., F.B., S.A., S.M., K.E.N.), SickKids Research Institute, Toronto, Ontario, Canada.
• J Pain Symptom Manage. 2024 Sep 1; 68 (3): 237245.e5237-245.e5.

ContextChildren with medical complexity have substantial medical needs and their caregivers must make many challenging decisions about their care. Caregivers often become more involved in decisions over time, but it is unclear what skills they develop that facilitate this engagement.ObjectivesTo describe the skills that caregivers developed as they gained experience making medical decisions.MethodsEligible caregivers had a child who met referral criteria for their centre's Complex Care program for >1 year, were adults responsible for their child's medical decisions, and spoke English or a language with an available interpreter. We followed a semistructured interview guide to ask caregivers to describe and reflect on two challenging medical decisions that they made for their child-one early and one recent. Guided by interpretive description, we identified and refined themes in an iterative process.ResultsWe conducted 15 interviews with 16 parents (14 [88%] women, two [13%] men) of a child with medical complexity (aged 1-17 years). Parents described 1) becoming more adept at managing decisional information, 2) recognizing the influence of the decision's context, 3) building stronger relationships with providers, and 4) becoming more effective at guiding their child's care as a decision-maker. As parents built these skills, they developed a greater sense of agency and confidence as decision-makers.ConclusionParents of children with medical complexity change how they approach decision making over time as they acquire relevant skills. These findings can inform the development of interventions to support skill-building among new caregivers.Copyright © 2024 American Academy of Hospice and Palliative Medicine. Published by Elsevier Inc. All rights reserved.

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