Pediatric Participation in Medical Decision Making: The Devil Is in the Details

Care-experienced young people's views on what they want from mental health services

This study explores what care-experienced young people want from mental health services. Six care-experienced young people were interviewed, and an interpretative phenomenological analysis applied. Three key themes emerged demonstrating that the way support is delivered, the people who deliver it, and the environment of mental health services are all important to care-experienced young people. Along with these findings, this study demonstrates that engaging vulnerable young people in research and service design is beneficial.

'I'm dealing with all these health issues that could have been addressed when I was younger'. Delivery of health services to Australian young people in out-of-home care: Lived experiences

Care-experienced young people demonstrate significantly poor physical, social and mental health outcomes during and beyond their time in care, yet they have rarely been consulted or included in research examining their health needs to date. This qualitative paper explores care-experienced young people's perceptions of health in care, including accessing healthcare and interacting with health professionals. The research methodology was informed by a co-design approach through consultation with care-experienced young people. Semi-structured interviews were conducted with 10 young people. The findings revealed that: (1) the care system does not nurture young people's health; (2) young people in care experience difficulty accessing and navigating a complex health system; and (3) young people are not given a voice when it comes to their health. The findings provide key recommendations for practice, including the empowerment of young people through positive, responsive and trusting relationships to prioritise the health of young people in care.

Use of language in the medical decision-making process for biologic therapy: Youth and parent perspectives

BACKGROUND

Youth with chronic illnesses and their parents make complex medical decisions and also need to develop medical decision-making skills for transition of care to adult care. The use of inclusive (e.g. 'we decided …') and exclusive (e.g. 'they decided …') language in youth and parents' medical decision-making experiences provides insights into perceptions of engagement. This study assessed youth and parents' perceptions of engagement in medical decision-making about biologic therapy.

METHODS

This exploratory mixed-methods secondary analysis of semistructured interview data included youth with juvenile idiopathic arthritis (JIA) and Crohn's disease (CD) and parents. Iterative qualitative coding of interviews generated themes. Exploratory analyses of variance (ANOVAs) and analyses of covariance (ANCOVAs) investigated differences in language use between youth and parents.

RESULTS

Parents used more inclusive language in perceptions of medical decision-making experiences than youth, which exploratory analyses found significant (p < 0.05). Youth used more exclusive language than parents in perceptions of medical decision-making.

CONCLUSION

This research suggests that youth with chronic illnesses perceived limited engagement in medical decision-making, with parents perceiving higher engagement. This presents challenges for youth as they prepare for the transition to adult care. Future research should assess how inclusive and exclusive language use impacts psychosocial and health outcomes.