Development of Competence for Decision-Making in Chronically Ill Children

Abstract

Assessing children's capacity for decision-making is a challenging task frequently faced by physicians.  Despite its importance, a review of the literature revealed very little empiric data on the one development of children's competence.  This experimental study compared the decision-making ability of 20 healthy and 20 chronically ill children between the ages of nine and fourteen.  A case-based interview protocol was used which defined four scales of competence:  Evidence of Choice, Reasonable Outcome, Rational Reasons, and Understanding (subdivided into Rote Recall and Inference).  The two groups of children performed equally well on the scales of Evidence of Choice, Reasonable Outcome, and Rational Reasons.  On the scale of Understanding, the healthy children scored a mean of 11.4% higher than the chronically ill group (p=0.02).  This difference was present across the two subscales (p=0.03 and p=0.05 for Rote Recall and Inference respectively).  Thus, in determining the proper role of ill children in medical decision-making, it is inappropriate to extrapolate from developmental data obtained from healthy children.  Further study must be done to clarify the magnitude and reasons for differences in the development of competence in chronically ill children as compared to healthy children.  In addition, further research is needed to determine whether similar case-based interviews could and should be used in a clinical setting to help assess the child'a appropriate degree of involvement in decisions about his or her own health care.