• Ellen A Lipstein, William B Brinkman, and Maria T Britto.
• Division of Adolescent Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, OH 45229, USA. ellen.lipstein@cchmc.org
• Med Decis Making. 2012 Mar 1;32(2):246-58.

BackgroundWith the increasing complexity of decisions in pediatric medicine, there is a growing need to understand the pediatric decision-making process.ObjectiveTo conduct a narrative review of the current research on parent decision making about pediatric treatments and identify areas in need of further investigation.MethodsArticles presenting original research on parent decision making were identified from MEDLINE (1966-6/2011), using the terms "decision making," "parent," and "child." We included papers focused on treatment decisions but excluded those focused on information disclosure to children, vaccination, and research participation decisions.ResultsWe found 55 papers describing 52 distinct studies, the majority being descriptive, qualitative studies of the decision-making process, with very limited assessment of decision outcomes. Although parents' preferences for degree of participation in pediatric decision making vary, most are interested in sharing the decision with the provider. In addition to the provider, parents are influenced in their decision making by changes in their child's health status, other community members, prior knowledge, and personal factors, such as emotions and faith. Parents struggle to balance these influences as well as to know when to include their child in decision making.ConclusionsCurrent research demonstrates a diversity of influences on parent decision making and parent decision preferences; however, little is known about decision outcomes or interventions to improve outcomes. Further investigation, using prospective methods, is needed in order to understand how to support parents through the difficult treatment decisions.

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