Perceptions of participation: child patients with a disability in the doctor-parent-child partnership

Abstract

Objective: To explore how the doctor-parent-child partnership is experienced and if the child patient is considered a contributor.

Methods: Qualitative methodology using semi-structured interviews with 33 participants (9 paediatricians, 14 parents, and 10 children aged 8-12 with cerebral palsy) from a paediatric teaching hospital in Victoria, Australia.

Results: Children were reported to participate in the doctor-parent-child partnership. The child was not perceived to be an 'equal' or 'regular' partner as there were reports of variability in the involvement between children, as well as variability in the progressive involvement of each child. Three categories emerged in relation to the child's position in the partnership: creating a space for the child's involvement; acknowledging the variability of child preferences to be involved; and negotiating the child's age and development.

Conclusion: The doctor-parent-child partnership was perceived not necessarily to be dyadic, shared exclusively by the parent and paediatrician. Children were reported to contribute to the partnership, although there were limitations to the child's involvement.

Practice implications: Previous understandings of partnership are not sufficient to explain the complexities involved in a doctor-parent-child partnership, and a social-model approach to care is highlighted as an important factor for enabling the development of a triadic partnership.