Open Access Open Badges Research article

Interventions to support children’s engagement in health-related decisions: a systematic review

Bryan Feenstra1, Laura Boland12, Margaret L Lawson23, Denise Harrison12, Jennifer Kryworuchko4, Michelle Leblanc5 and Dawn Stacey16*

Author Affiliations

1 University of Ottawa, Faculty of Health Sciences, Ottawa, ON, Canada

2 Children’s Hospital of Eastern Ontario Research Institute, Ottawa, ON, Canada

3 Children’s Hospital of Eastern Ontario, Ottawa, ON, Canada

4 University of Saskatchewan College of Nursing, Saskatoon, SK, Canada

5 University of Ottawa, Health Sciences Library, Ottawa, ON, Canada

6 Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON, Canada

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BMC Pediatrics 2014, 14:109  doi:10.1186/1471-2431-14-109

Published: 23 April 2014



Children often need support in health decision-making. The objective of this study was to review characteristics and effectiveness of interventions that support health decision-making of children.


A systematic review. Electronic databases (PubMed, the Cochrane Library, Web of Science, Scopus, ProQuest Dissertations and Theses, CINAHL, PsycINFO, MEDLINE, and EMBASE) were searched from inception until March 2012. Two independent reviewers screened eligibility: a) intervention studies; b) involved supporting children (≤18 years) considering health-related decision(s); and c) measured decision quality or decision-making process outcomes. Data extraction and quality appraisal were conducted by one author and verified by another using a standardized data extraction form. Quality appraisal was based on the Cochrane Risk of Bias tool.


Of 4313 citations, 5 studies were eligible. Interventions focused on supporting decisions about risk behaviors (n = 3), psycho-educational services (n = 1), and end of life (n = 1). Two of 5 studies had statistically significant findings: i) compared to attention placebo, decision coaching alone increased values congruence between child and parent, and child satisfaction with decision-making process (lower risk of bias); ii) compared to no intervention, a workshop with weekly assignments increased overall decision-making quality (higher risk of bias).


Few studies have focused on interventions to support children’s participation in decisions about their health. More research is needed to determine effective methods for supporting children’s health decision-making.

Child; Adolescent; Decision making; Patient participation; Practice