A review of children's decision-making competence in health care.

AIMS AND OBJECTIVES The purpose of this literature review was to search for and review, systematically, children's decision-making competence in health care in the scientific literature. Findings of both quantitative and qualitative studies were analysed thematically. BACKGROUND Most previous research in children's decision-making competence in health care concerns adults' care in the best interests of the child. It is important to consider decision-making competence from the child's perspective because of children's own human rights. METHODS Systematic review including database search, manual selection, supplementary searching, management and acquisition of relevant literature, quality appraisal, literature review saturation and thematic review. RESULTS Six themes emerged: measurable issues, values and beliefs, power, parent-related communication, trust and self-determination. Measurable issues were age, reading ability and memory. Values and beliefs as well as power and parent-related communication were associated with healthcare professionals. Children showed trust and expressed a wish to use self-determination. CONCLUSIONS Age appropriate information and participation were prerequisites for allowing children to have possibilities of making competent decisions about their own care. Children's decision-making competence is dependent on others, such as parents and healthcare professionals, attitudes and not only on their own capacity. Lack of competence, however, does not exclude children from the human right to have a say. It should be noted that it is a decision to leave the determination to a parent or healthcare professional. RELEVANCE TO CLINICAL PRACTICE Future research from the viewpoint of children is important to reach optimal levels of participation, through respecting their integrity and to develop them into potential competent decision makers.