FRINK Linked Data Fragments server

Matches in SemOpenAlex for { <https://semopenalex.org/work/W3107691331> ?p ?o ?g. }

• W3107691331 endingPage "264" @default.
• W3107691331 startingPage "259" @default.
• W3107691331 abstract "Pediatricians often serve as interpreters and mediators of health guidelines when discussing vaccines, health screening, and lifestyle choices with parents of our patients. Outside of public health emergencies, these discussions nearly exclusively focus on optimizing the health of the individual child and a focus on family preferences. However, in the current pandemic, nearly everyone has experienced limitations of personal activities for the population health goal of curbing the spread of the novel coronavirus disease-2019 (COVID-19). New information continues to become available about infrequent but serious COVID-19 complications in children, including neurologic and inflammatory sequalae from illness, as well as the role children play in the spread of the virus.1Abdel-Mannan O. Eyre M. Löbel U. Bamford A. Eltze C. Hameed B. et al.Neurologic and radiographic findings associated with COVID-19 infection in children.JAMA Neurol. 2020; 77: 1-6Crossref Scopus (266) Google Scholar, 2Feldstein L.R. Rose E.B. Horwitz S.M. Collins J.P. Newhams M.M. Son M.F. et al.Multisystem inflammatory syndrome in U.S. children and adolescents.N Engl J Med. 2020; 383: 334-346Crossref PubMed Scopus (1598) Google Scholar, 3Wald E.R. Schmit K.M. Gusland D.Y. A pediatric infectious disease perspective on COVID-19.Clin Infect Dis. 2020; ([Epub ahead of print])Crossref Scopus (18) Google Scholar Moreover, children of color experience a greater proportion of severe COVID-19-related disease, including higher rates of hospitalization and death.4Rabin R.C. Why the Coronavirus more often strikes children of color.www.nytimes.com/2020/09/01/health/coronavirus-children-minorities.htmlDate accessed: November 20, 2020Google Scholar We also know that the measures helping to control COVID-19 infection rates have negatively impacted the health of children through delays in routine vaccination and well-child care, the mental health consequences of school closures, and heightened concerns about the risk of child abuse in socially isolated children.5United Nations Sustainable Development GroupThe impact of COVID-19 on children.https://unsdg.un.org/resources/policy-brief-impact-covid-19-childrenDate accessed: November 20, 2020Google Scholar, 6Feltman D.M. Moore G.P. Beck A.F. Sifferman E. Bellieni C. Lantos J. Seeking normalcy as the curve flattens: ethical considerations for pediatricians managing collateral damage of COVID-19.J Pediatr. 2020; 225: 233-238Abstract Full Text Full Text PDF PubMed Scopus (7) Google Scholar, 7Rosenthal C.M. Thompson L.A. Child Abuse Awareness Month during the coronavirus disease 2019 pandemic.JAMA Pediatr. 2020; 174: 812Crossref PubMed Scopus (37) Google Scholar These unintended consequences are presumed to be acceptable harms to protect the public health. As children return to medical care and some return to in-person schooling, pediatricians are now tasked with navigating concepts in public health ethics when helping parents make decisions affecting their children and the larger community. The American Academy of Pediatrics (AAP) has released guidance on face coverings, testing protocols, and the use of personal protective equipment in the context of communities and schools trying to reopen even as rates of new COVID-19 infections increase.8American Academy of PediatricsCloth face coverings.https://services.aap.org/en/pages/2019-novel-coronavirus-covid-19-infections/clinical-guidance/cloth-face-coverings/Date accessed: November 20, 2020Google Scholar Nonetheless, questions for pediatricians remain problematic. How can pediatricians balance the needs of their patients with those of the population at large during the COVID-19 public health crisis? How should pediatricians respond when parents’ preferences do not align with public health strategies? What adjustments must be made to the typical model of pediatric shared decision-making (SDM) when guiding parents through clinical decisions that benefit the population as a whole, but lead to limiting choices of the individual patient? In this commentary, we examine how values typically prioritized in public health ethics such as solidarity and justice can be integrated into SDM, where the individual child's best interest and caregiver preferences are often paramount. Additionally, we suggest a framework to integrate public health ethics into the traditional SDM continuum using 4 scenarios that we examine for risks, benefits, settings, and appropriate levels of directiveness. Although maintaining an awareness of the evolving epidemiology of COVID-19, and in particular, its impact on vulnerable groups, pediatricians must have a solid working knowledge of public health ethics and law to allow them to navigate these conversations effectively. When multiple ethically reasonable approaches to care exist, parents or legal guardians (caregivers) and pediatricians typically engage in SDM, grounded in principles of caregiver authority (respect for autonomy) and the child's best interests (beneficence).9Kon A.A. The shared decision-making continuum.JAMA. 2010; 304: 903-904Crossref PubMed Scopus (309) Google Scholar Both parties bring knowledge, values, and preferences to the discussion and work collaboratively, negotiating the contributions of each party to the decision making process and facilitating information exchange to decide what is best for the child, within the context of family goals. The process is highly value sensitive and, importantly, relies on the provider encouraging a bidirectional exchange of information to elicit patient and caregiver preferences.10Global Seminar Salzburg Salzburg statement on shared decision making.BMJ. 2011; 342: d1745Crossref PubMed Scopus (158) Google Scholar SDM generally defers the decision to caregiver views of what is “best” provided they are reasonable and do not lead to harm for the child.11Katz A.L. Webb S.A. American Academy of Pediatrics Committee on BioethicsInformed consent in decision-making in pediatric practice.Pediatrics. 2016; 138: e20161485Crossref PubMed Scopus (179) Google Scholar In public health emergencies, the principles of beneficence (maximizing benefit), and nonmaleficence (avoiding harm) that commonly guide individual decisions in health care are viewed instead through the lens of impact at the population level. Values of justice (the fair distribution of societal burdens and benefits) and solidarity increase in importance. Solidarity is characterized as affirming the moral standing of others and their membership in a community of equal dignity and respect. As Jennings summarizes, solidarity emphasizes an “attention to the moral (and mortal) being of others and their needs, suffering, and vulnerability.”12Jennings B. Relational ethics for public health: interpreting solidarity and care.Health Care Anal. 2019; 27: 4-12Crossref PubMed Scopus (14) Google Scholar Solidarity can also be understood as a call to stand with or assist community members for overall community good and a method to combat structural and systemic injustices.13Gould C. Solidarity and the problem of structural injustice in healthcare.Bioethics. 2018; 32: 541-552Crossref PubMed Scopus (25) Google Scholar Applying these values may at times conflict with principles guiding individual health decisions, such as autonomy.14Gostin L.O. Jacobson V. Massachusetts at 100 years: police power and civil liberties in tension.Am J Public Health. 2005; 95: 576-581Crossref PubMed Scopus (56) Google Scholar The state's police powers to safeguard its people permit paternalistic restrictions on individual liberties when the population-level benefits of the interventions outweigh the harms of individual restrictions. Protection is sometimes achieved through restrictions to individual liberties to actively prevent 1 person from making choices that increase the risk of harm to others. When public health authorities legally mandate a public health practice, the intervention must prevent an avoidable harm, have a “real or substantial relation” to protecting public health, ensure that burdens are not disproportionate to expected benefits, and not pose undue risks.15Harlan, John Marshall, Supreme Court of the United StatesU.S. Reports: Jacobson v. Massachusetts, 197 U.S. 11.www.loc.gov/item/usrep197011/Date: 1904Date accessed: November 20, 2020Google Scholar Interventions are also justified under frameworks of public health ethics when the intervention is effective, offers significant public health benefit, confers minimal individual burden and risk, and distributes burdens and benefits fairly.16Kass N.E. An ethics framework for public health.Am J Public Health. 2001; 91: 1776-1782Crossref PubMed Scopus (616) Google Scholar When such conditions are met, pediatricians (within their practices) and public health officials may have more authority to impose such interventions. However, these interventions may run counter to caregiver preferences under traditional SDM. As described elsewhere in the Commentary, the traditional SDM framework is guided by caregiver and patient goals and values. The public health framework requires serious attention to population-level goals and, therefore, heavily relies on the consideration of risks or burdens and benefits at the population level, even if these measures require subsuming some individual interests to meet the goals of justice and solidarity. Pediatricians accustomed to the traditional SDM framework need to navigate these discussions of risk, burden, and benefit at both the individual and population levels when guiding parents through individual health decisions and considerations of various public health interventions. Contributions to SDM may shift from the traditional model, as demonstrated in the Figure. Under traditional SDM, pediatricians defer to caregiver choices, offering more directive recommendations as interventions present children lower risks and higher benefits. Contributions to decision making will be most equally distributed between physician and caregiver when neither benefits nor risks to the child predominate, with differential ratios of risks and benefits shifting contributions to decision making more toward physician or caregiver. Public health decision making prioritizes solidarity, justice, and law, resulting in more physician directiveness when interventions present high population benefits, fairly distributed burdens proportionate to benefits, and low risks or harms to child. To this end, pediatricians will need become facile in discussing justice considerations with families and older children and explain how following public health guidelines benefits communities as a whole and those that might be at greater risk. We discuss 4 applications of the combined SDM and public health frameworks relevant to COVID-19. These examples, although not exhaustive, were chosen to illustrate varying risk-benefit profiles to the individual and population. Under this framework, information exchange that occurs in SDM will need to include a discussion of the risks and benefits to public health when appropriate. Contributions to SDM will differ depending on the population-level benefits of particular interventions and the risks and benefits to the child. Such conversations should nonetheless incorporate patient and caregiver preferences to the greatest extent possible, respecting traditional principles of SDM. Because people may be asymptomatic carriers of COVID-19, masks are recommended to prevent transmission when social distancing is not possible, except in very young children or those with medical conditions precluding their use.17Chu D.K. Akl E.A. Duda S. Solo K. Yaacoub S. Schunemann H.J. Physical distancing, face masks, and eye protection to prevent person-to-person transmission of SARS-CoV-2 and COVID-19: a systematic review and meta-analysis.Lancet. 2020; 395: 1973-1987Abstract Full Text Full Text PDF PubMed Scopus (2483) Google Scholar However, there is no national masking policy and recommendations remain variable across different regions.18Miller H. Coronavirus mask mandates differ across the country as hot spots multiply and states play politics.www.cnbc.com/2020/06/26/coronavirus-mask-mandates-differ-across-the-country-as-hot-spots-multiply.htmlDate accessed: November 20, 2020Google Scholar Pediatricians may encounter decisions about mask wearing both within the context of policies and practices within their own clinical environment and in helping families navigate the potential need for mask wearing in other settings. Public health ethics principles described above would support pediatricians who mandate mask wearing in clinical settings given the minimal burden to wearers and collective benefits for other patients and staff. Masking can be thought of as a universal precaution similar to immunizations; both are intended to afford the individual protection, but also to diminish disease transmission to others. Similar to the case of vaccinations, pediatricians may be asked by some caregivers to allow exceptions to rules for mask wearing. Permissible exceptions will require strong medical justification, such as medical conditions in which the mask would make breathing difficult or if an individual lacks the capacity to remove the mask, such as children younger than 2 years of age or those with severe neurodevelopmental impairments. One might also consider allowing exceptions for a child with strong behavioral challenges that practically make wearing a mask very difficult—if the struggle to continue the mask wearing could actually increase transmission of viral particles, clearly the benefit of the mask would be lost. In such circumstances, alternatives to masks such as face shields or alternatives to visits in the clinical setting, such as a telehealth appointment, should be considered when feasible. Negotiating such conversations requires balancing the public health benefits of mask wearing with the potential individual risks and benefits associated with the practice. Only when there are compelling risks to the patient or loss of benefit to the public would it be ethically acceptable for pediatricians to accommodate requests to exempt patients from mask wearing requirements or to recommend against mask wearing generally.17Chu D.K. Akl E.A. Duda S. Solo K. Yaacoub S. Schunemann H.J. Physical distancing, face masks, and eye protection to prevent person-to-person transmission of SARS-CoV-2 and COVID-19: a systematic review and meta-analysis.Lancet. 2020; 395: 1973-1987Abstract Full Text Full Text PDF PubMed Scopus (2483) Google Scholar Community rates of disease and acceptance of masking varies across regions and at different points in time. Compliance becomes more critical as rates of infection increase. Exceptions to masking, therefore, may vary in impact based on the local disease burden at the time in question. However, the best practice remains to counsel universal masking, regardless of rates of COVID-19, so that when exceptions are necessary, those surrounding the child are in compliance and making the situation as safe as possible. Conversely, pediatricians may need to support patients seeking to protect themselves and others but who are struggling with family or community members who do not comply with public health recommendations. Pediatricians can equip families with evidence, information, and tools to help facilitate conversations with family members or community members (eg, how to get a child to become comfortable with mask wearing, why masking protects others, airborne transmission in indoor gathering vs outdoor gatherings, etc).19American Academy of PediatricsCOVID 19.www.healthychildren.org/English/health-issues/conditions/COVID-19/Pages/default.aspxDate accessed: November 20, 2020Google Scholar Many hospitals require COVID-19 testing of asymptomatic children before certain invasive procedures and hospital admissions. Although some patients may individually benefit from knowing test results, the primary benefit of testing is not to the individual, but to facilitate appropriate levels of infection control, including proper room assignment, judicious use of personal protective equipment, and optimizing hospital operations.20Centers for Disease Control and PreventionGuidance for healthcare professionals who have the potential for direct or indirect exposure to patients or infectious materials.www.cdc.gov/coronavirus/2019-ncov/hcp/infection-control-recommendations.htmlDate accessed: November 20, 2020Google Scholar Some parents may prefer to forego testing to avoid the perceived burden of discomfort to the child. Although this is a small but real burden to the child, the benefits of protecting health care resources and other patients make mandating COVID-19 testing ethically permissible. However, accommodations may need to be considered as burdens and risks to patient increase (eg, for children who may have such significant aversions that they would require sedation to tolerate testing). As testing methods become less invasive, more rapid and reliable, and available in greater volumes, risks and benefits will continue to evolve. The AAP has recently advocated for continued asymptomatic testing after contact exposure because of the high rates of many (but not all) asymptomatic children.21Goza S. AAP statement on CDC recommendations against COVID-19 testing for asymptomatic individuals.https://services.aap.org/en/news-room/news-releases/aap/2020/aap-statement-on-cdc-recommendation-against-covid-19-testing-for-asymptomatic-individuals/Date accessed: November 20, 2020Google Scholar Mandating repeated testing protocols such as those proposed to allow for safer activities (eg, testing every few days of on-campus college students) should improve the calculus of the benefits over risks, although even despite such a program, for example, at the University of Illinois at Urbana-Champaign, surges have forced temporary in-person instruction closures.22Nadworny E. Despite mass testing, University of Illinois sees coronavirus cases rise. NPR.www.npr.org/sections/coronavirus-live-updates/2020/09/03/909137658/university-with-model-testing-regime-doubles-down-on-discipline-amid-case-spikeDate accessed: November 20, 2020Google Scholar When a vaccine is available, supplies will likely be limited, requiring consideration of whom should be prioritized for vaccination. Children will be an important population to vaccinate, given potential for spreading through asymptomatic carrier children, particularly as schools and daycares reopen. Pediatricians will need to engage families in SDM and directive counseling to the weigh benefits of viral protection for the child and others against possible unknown risks. There also exists a need from professional societies and the public health infrastructure to provide clear guidance and messaging on the importance of vaccination specifically in the context of COVID-19.23Mello M.M. Silverman R.D. Omer S.B. Ensuring uptake of vaccines against SARS-CoV-2.N Engl J Med. 2020; 383: 1296-1299Crossref PubMed Scopus (64) Google Scholar Returning children to school safely is important for academics and the healthy development and well-being of children, and although this goal remains elusive for many reasons, mass vaccination of children may need to be an important consideration.24American Academy of PediatricsCOVID-19 planning considerations: guidance for school re-entry.https://services.aap.org/en/pages/2019-novel-coronavirus-covid-19-infections/clinical-guidance/covid-19-planning-considerations-return-to-in-person-education-in-schools/Date accessed: November 20, 2020Google Scholar Nevertheless, mandating vaccination soon after release would be fraught with challenges given the accelerated vaccine development timeline, potential unknown risks and complications, and evolving understanding of COVID-19 epidemiology.25O’Callaghan K.P. Blatz A.M. Offit P.A. Developing a SARS-CoV-2 vaccine at warp speed.JAMA. 2020; 324: 437-438Crossref PubMed Scopus (52) Google Scholar,26Lurie N. Sharfstein J.M. Goodman J.L. The development of COVID-19 vaccines: safeguards needed.JAMA. 2020; 324: 439-440Crossref PubMed Scopus (48) Google Scholar The US Food and Drug Administration's options for approving a new vaccine (whether a vaccine works) will depend on its efficacy, its proportional uptake, and the rates of the virus in that community. Whether a vaccine is safe will be gauged by risks and degrees of harm agreed upon as acceptable.27Shah A. Marks P.W. Hahn S.M. Unwavering regulatory safeguards for COVID-19 vaccines.JAMA. 2020; 324: 931-932Crossref PubMed Scopus (40) Google Scholar Despite the anticipated public health benefits of achieving herd immunity and the possibility of returning to school faster, prematurely mandating COVID-19 vaccination could also aggravate hesitancy and refusals pediatricians already face with vaccines.28Gidengil C. Chen C. Parker A.M. Nowak S. Matthews L. Beliefs around childhood vaccines in the United States: a systematic review.Vaccine. 2019; 37: 6793-6802Crossref PubMed Scopus (51) Google Scholar These considerations are likely to be more salient in communities of color, who have already suffered a disproportionate burden of disease. For COVID-19, involvement in vaccine trials has also been lower for Black participants, which may also contribute to increasing vaccine hesitancy in the future.29Farmer B. As Covid-19 vaccine trials move at warp speed, recruiting black volunteers takes time.www.npr.org/sections/health-shots/2020/09/11/911885577/as-covid-19-vaccine-trials-move-at-warp-speed-recruiting-black-volunteers-takesDate accessed: November 20, 2020Google Scholar Therefore, parents should be allowed to refuse any potential COVID-19 vaccine until the risks and efficacy are well-established in children. When a COVID-19 vaccine is deemed to be safe and available for distribution to children, pediatricians will be asked to help interpret for families the guidance from federal agencies and professional societies such as the AAP to make thoughtful decisions for their children. Pediatricians who have already established trusting relationships with their patients will be the best ambassadors for vaccine-related questions. Families who display vaccine hesitancy for existing immunizations will benefit from pediatricians who strengthen families’ health literacy and who use proven methods to ensure understanding of information, including information technology.30Marti M. de Cola M. MacDonald N.E. Dumolard L. Duclos P. Assessments of global drivers of vaccine hesitancy in 2014-Looking beyond safety concerns.PLoS One. 2017; 12: e0172310Crossref PubMed Scopus (115) Google Scholar, 31Gianfredi V. Moretti M. Lopalco P.L. Countering vaccine hesitancy through immunization information systems, a narrative review.Hum Vaccin Immunother. 2019; 15: 2508-2526Crossref PubMed Scopus (39) Google Scholar, 32Goodman J.L. Grabenstein J.D. Braun M.M. Answering key questions about COVID-19 vaccines.JAMA. 2020; ([Epub ahead of print])Crossref PubMed Scopus (24) Google Scholar Therapeutics for COVID-19 remain under investigation, and some children suffer serious postinfectious complications.2Feldstein L.R. Rose E.B. Horwitz S.M. Collins J.P. Newhams M.M. Son M.F. et al.Multisystem inflammatory syndrome in U.S. children and adolescents.N Engl J Med. 2020; 383: 334-346Crossref PubMed Scopus (1598) Google Scholar Pediatricians should anticipate counseling families about current knowledge on alternative treatments and assist them in understanding the risks and benefits of enrolling infected children in pediatric studies. Participation of children in COVID-19 research studies remains important so that children have appropriate and early access to future medical treatments and support for psychological sequelae; such sequelae have been reported during and after natural disasters. For observational studies (eg, tracking outcomes for children with multisystem inflammatory syndrome in children) that pose minimal risk to the child, pediatricians may be more directive in recommending participation while being mindful that children may have special vulnerabilities after a traumatic event like this pandemic.33Ferreira R.J. Buttell F. Cannon C. Ethical issues in conducting research with children and families affected by disasters.Curr Psychiatry Rep. 2018; 20: 42Crossref PubMed Scopus (5) Google Scholar In contrast, investigational treatments with higher potential harms but possible benefits such as an unproven medication to prevent multisystem inflammatory syndrome in children in a child infected with COVID-19 or a vaccine trial will likely pose greater risks to the child and require careful exploration by pediatrician and caregiver with more deference to caregiver preferences. Specifically, the AAP has advocated for the inclusion of children in research on potential COVID-19 vaccine and said:[I]t is counter to the ethical principle of distributive justice to allow children to take on great burdens during this pandemic but not have the opportunity to benefit from a vaccine, or to delay that benefit for an extended period of time, because they have not been included in vaccine trials. Children must be included in vaccine trials to best understand any potential unique immune responses and/or unique safety concerns.34American Academy of PediatricsLetter to HHS and FDA-Children in COVID 19 Vaccine Trials.https://downloads.aap.org/DOFA/AAPLettertoHHSandFDAChildreninCOVID19VaccineTrials.pdfDate accessed: November 20, 2020Google Scholar Recently, children older than age 12 years are eligible to participate in COVID-19 vaccine clinical trials.35Aubrey A. Will kids get a COVID-19 vaccine? Pfizer to expand trial to ages 12 and up.www.npr.org/sections/health-shots/2020/10/13/923248377/will-kids-get-a-covid-19-vaccine-pfizer-to-expand-trial-to-ages-12-and-upDate accessed: November 20, 2020Google Scholar Families considering participating will need to weigh risk to their child as well as the potential public health benefit; pediatricians can support caregivers’ decision making by helping the family to understand the potential overall benefit to the adolescent and ensure there is assent from the adolescent. Ultimately, deference should be given to caregiver choices. Adolescents have developing autonomy and some may have decision making capacity similar to that of an adult and should participate in SDM as it pertains to their own health care. When adolescent values differ from that of their family and impact health care choices, pediatricians need to share information, practice good communication, ensure transparency, and sometimes engage in conflict resolution. If there is a disagreement related to COVID-19 where a family endorses masking, social distancing, and testing, but the adolescent does not, the pediatrician may need to explore personal and community barriers and provide best practice guidance through evidence-based current public health recommendations. Although state laws differ in adolescents' ability to give sole consent for immunizations, the pediatrician can strive to help parents and the patient arrive at a shared decision by providing a space for clarifying concerns, medical facts, and goals in a way that respects both stakeholders. Finally, the pediatrician may need to help support decision making that allows the adolescent to feel safe, such as if the patient attends school in a region where there is no masking requirement. In each scenario, the pediatrician will need to assess the adolescent's level of evolving decision-making capacity to help titrate information delivery, the deliberation over risks and benefits, and the degree of adolescent participation in decision making. Minority groups have experienced higher rates of illness and mortality from COVID-19. Higher rates of infection and mortality are due, in large part, to systemic biases and structural inequities that create baseline disparate health care access, quality, and outcomes for certain groups of people.36Abedi V. Olulana O. Avula V. Chaudhary D. Khan A. Shahjouei S. et al.Racial, economic and health inequality and COVID-19 infection in the United States.J Racial Ethn Health Disparities. 2020; : 1-11PubMed Google Scholar Of the nearly 800 reported cases of multisystem inflammatory syndrome in children, 70% occurred in Black and Hispanic/Latino children.37Center for Disease Control and PreventionHealth department-reported cases of multisystem inflammatory syndrome in children (MIS-C) in the United States.www.cdc.gov/mis-c/cases/ind37,ex.htmlDate accessed: November 20, 2020Google Scholar The very same groups that would most likely benefit from an effective vaccine or study of this disease have also shown greater rates of mistrust in the health system and in research attributable to historical experiences of unethical treatment.38Sullivan L.S. Trust, risk, and race in American medicine.Hastings Cent Rep. 2020; 50: 18-26Crossref PubMed Scopus (55) Google Scholar Given this delicate juxtaposition of need and trust, public health efforts that aim to address health equity have the best chances of restoring faith in general medical care. This dynamic generates additional considerations and challenges for pediatricians who counsel minority families in situations where public health goals may differ from individual preferences. Pediatricians need to use models that bridge the gaps between health care professionals and the families they serve, especially in the face of different cultural experiences.39Ellis W.R. Dietz W.H. A new framework for addressing adverse childhood and community experiences: the building community resilience model.Acad Pediatr. 2017; 17: S86-S93Abstract Full Text Full Text PDF PubMed Scopus (157) Google Scholar Preserving and respecting SDM requires that pediatricians engage in thoughtful and informed dialogue with special attention to reflective listening, incorporation of health-literate sensitive educational materials, acknowledgement of explicit and implicit biases, awareness and validation of current and past mistreatment, and with attention to the potential for institutional inequities to build trust and to avoid perpetuating existing disparities.40Derrington S.F. Paquette E. Johnson K.A. Cross-cultural interactions and shared decision-making.Pediatrics. 2018; 142: S187-S192Crossref PubMed Scopus (26) Google Scholar Any consideration of mandatory interventions in particular should include specific attention to measuring the impact on groups at risk for disparities and gauging whether changes in structural and systemic practices may have unintended consequences that worsen existing disparities and mistrust.41Trent M. Dooley D.G. Dougé J, Section on Adolescent Health, Council on Community Pediatrics, Committee on Adolescence. The impact of racism on child and adolescent health.Pediatrics. 2019; 144: e20191765Crossref PubMed Scopus (499) Google Scholar It is important to note that, in addition to considerations for their interpersonal interactions with caregivers and families, to further principles of public health ethics, pediatricians also have a special role in addressing these structural and systemic issues as advocates for children. It is especially important that existing disparities are not worsened when negotiating public health goals and SDM. Interventions offering high chances of benefit to the population and low risks to individuals may be ethically mandated by pediatricians and legally mandated by public health officials under ethical and legal public health frameworks. As risks to the individual patient increase in likelihood or in degree of harmfulness, a more traditional SDM model emphasizing individual goals may be most appropriate. By integrating public health law and ethics into traditional models of SDM, pediatricians can guide families through decisions affecting public health and their children." @default.
• W3107691331 created "2020-12-07" @default.
• W3107691331 creator A5042358279 @default.
• W3107691331 creator A5052219148 @default.
• W3107691331 creator A5080502047 @default.
• W3107691331 date "2021-04-01" @default.
• W3107691331 modified "2023-09-24" @default.
• W3107691331 title "Integrating Public Health Ethics into Shared Decision Making for Children During the Novel Coronavirus Disease-19 Pandemic" @default.
• W3107691331 cites W1949758479 @default.
• W3107691331 cites W2061276405 @default.
• W3107691331 cites W2084460581 @default.
• W3107691331 cites W2095115808 @default.
• W3107691331 cites W2506793933 @default.
• W3107691331 cites W2593603912 @default.
• W3107691331 cites W2752373223 @default.
• W3107691331 cites W2803431388 @default.
• W3107691331 cites W2884796846 @default.
• W3107691331 cites W2898018897 @default.
• W3107691331 cites W2899392015 @default.
• W3107691331 cites W2929392239 @default.
• W3107691331 cites W2965936938 @default.
• W3107691331 cites W2974938419 @default.
• W3107691331 cites W3007087634 @default.
• W3107691331 cites W3018639370 @default.
• W3107691331 cites W3032742287 @default.
• W3107691331 cites W3037223926 @default.
• W3107691331 cites W3038003713 @default.
• W3107691331 cites W3038042287 @default.
• W3107691331 cites W3038345433 @default.
• W3107691331 cites W3038531310 @default.
• W3107691331 cites W3038938150 @default.
• W3107691331 cites W3047960534 @default.
• W3107691331 cites W3048188919 @default.
• W3107691331 cites W3081710107 @default.
• W3107691331 cites W3092938363 @default.
• W3107691331 doi "https://doi.org/10.1016/j.jpeds.2020.11.061" @default.
• W3107691331 hasPubMedCentralId "https://www.ncbi.nlm.nih.gov/pmc/articles/7706416" @default.
• W3107691331 hasPubMedId "https://pubmed.ncbi.nlm.nih.gov/33275982" @default.
• W3107691331 hasPublicationYear "2021" @default.
• W3107691331 type Work @default.
• W3107691331 sameAs 3107691331 @default.
• W3107691331 citedByCount "3" @default.
• W3107691331 countsByYear W31076913312021 @default.
• W3107691331 countsByYear W31076913312022 @default.
• W3107691331 crossrefType "journal-article" @default.
• W3107691331 hasAuthorship W3107691331A5042358279 @default.
• W3107691331 hasAuthorship W3107691331A5052219148 @default.
• W3107691331 hasAuthorship W3107691331A5080502047 @default.
• W3107691331 hasBestOaLocation W31076913311 @default.
• W3107691331 hasConcept C116675565 @default.
• W3107691331 hasConcept C138816342 @default.
• W3107691331 hasConcept C142724271 @default.
• W3107691331 hasConcept C159047783 @default.
• W3107691331 hasConcept C159110408 @default.
• W3107691331 hasConcept C2777648638 @default.
• W3107691331 hasConcept C2779134260 @default.
• W3107691331 hasConcept C3006700255 @default.
• W3107691331 hasConcept C3007834351 @default.
• W3107691331 hasConcept C3008058167 @default.
• W3107691331 hasConcept C524204448 @default.
• W3107691331 hasConcept C71924100 @default.
• W3107691331 hasConcept C89623803 @default.
• W3107691331 hasConcept C99454951 @default.
• W3107691331 hasConceptScore W3107691331C116675565 @default.
• W3107691331 hasConceptScore W3107691331C138816342 @default.
• W3107691331 hasConceptScore W3107691331C142724271 @default.
• W3107691331 hasConceptScore W3107691331C159047783 @default.
• W3107691331 hasConceptScore W3107691331C159110408 @default.
• W3107691331 hasConceptScore W3107691331C2777648638 @default.
• W3107691331 hasConceptScore W3107691331C2779134260 @default.
• W3107691331 hasConceptScore W3107691331C3006700255 @default.
• W3107691331 hasConceptScore W3107691331C3007834351 @default.
• W3107691331 hasConceptScore W3107691331C3008058167 @default.
• W3107691331 hasConceptScore W3107691331C524204448 @default.
• W3107691331 hasConceptScore W3107691331C71924100 @default.
• W3107691331 hasConceptScore W3107691331C89623803 @default.
• W3107691331 hasConceptScore W3107691331C99454951 @default.
• W3107691331 hasLocation W31076913311 @default.
• W3107691331 hasLocation W31076913312 @default.
• W3107691331 hasLocation W31076913313 @default.
• W3107691331 hasOpenAccess W3107691331 @default.
• W3107691331 hasPrimaryLocation W31076913311 @default.
• W3107691331 hasRelatedWork W3012336022 @default.
• W3107691331 hasRelatedWork W3040137343 @default.
• W3107691331 hasRelatedWork W3045573749 @default.
• W3107691331 hasRelatedWork W3046519041 @default.
• W3107691331 hasRelatedWork W3046807162 @default.
• W3107691331 hasRelatedWork W3046884912 @default.
• W3107691331 hasRelatedWork W3089198401 @default.
• W3107691331 hasRelatedWork W3194513569 @default.
• W3107691331 hasRelatedWork W3208092296 @default.
• W3107691331 hasRelatedWork W4365462004 @default.
• W3107691331 hasVolume "231" @default.
• W3107691331 isParatext "false" @default.
• W3107691331 isRetracted "false" @default.
• W3107691331 magId "3107691331" @default.
• W3107691331 workType "article" @default.