PS 4-46
HOW DO CHILDREN AND PARENTS WANT TO BE INVOLVED IN MAKING DECISIONS FOR CHILD ANXIETY AND DEPRESSION TREATMENT?: A QUALITATIVE STUDY
Methods: Parents (n = 16) and children (n = 12, age range 8 – 14 years, MAge = 10.92 years) who were seeking treatment for childhood depression and/or anxiety were invited to participate in semi-structured qualitative interviews about their preferred roles in treatment decision planning. Interviews were transcribed and coded for analysis guided by a Grounded Theory framework (Glaser & Strauss, 1967). Analyses in the present study focus on providing a “thick” description of participant perspectives (Geertz, 1994), relating variability in perspectives to demographic characteristics and clinical presentations, and comparing and contrasting parent and child perspectives.
Results: Parents and children described a variety of potential roles for themselves in the treatment planning process, including providing information, learning information, collaborating, unilaterally making decisions, generally engaging, deferring to others, sharing opinions, and providing emotional support. All parents preferred their child be involved in the treatment planning process; the degree of involvement preferred by parents ranged from the child joining the discussion after the parent and therapist have made most decisions, to serving as the primary decision maker unless it is a matter of safety. Parent preferences did not appear to vary systematically by the child’s age or developmental level, but instead by parenting style, values regarding child autonomy, and parental judgment regarding their child’s ability to make competent decisions. Parents, at minimum, preferred “veto” power to any decision with which they disagreed. All children wanted at least some role, but the amount of autonomy they preferred varied considerably. Children were more likely than parents to express multiple (and occasionally conflicting) preferences over the course of the interview.
Conclusions: Parent and child perspectives on their roles in the treatment planning process are highly variable and more predicted by parenting style instead of the age or developmental level of the child. Despite the variability, it is clear that all parents and children interviewed valued some form of involvement in the treatment planning process. This foundational qualitative descriptive research on preferred roles in treatment decision-making will inform the design of shared decision-making interventions to enhance treatment of parents and children who are receiving pediatric mental health care.