Parental Decision-Making

The issue

From the time any baby is born, parents start to make decisions that can have lifelong impact on their child. Parental child-rearing knowledge, experiences, and personal and cultural values and beliefs will influence these decisions—decisions that become more complex and stressful when a child is identified as deaf or hard of hearing (DHH). Hearing parents, in particular, do not have the lived experience or knowledge about raising a child with hearing loss. They must rely on the professionals working with their child to provide the information and guidance they need to make informed decisions.

Decision-making is a fundamental part of everyday life. Most decisions need little thought or attention, and this works well most of the time. Other decisions, however, need a more logical and thoughtful approach to achieve desired goals or outcomes. Many of the important decisions made by parents regarding their DHH child require them to take this more careful approach. Research into decision-making in a variety of disciplines highlights that all individuals, even experts in their field, can make systematic errors in thinking, known as cognitive biases, when making decisions. These biases are subconscious and can lead to faulty interpretations, inaccurate conclusions, and mistaken impressions of the facts, resulting in poor decisions.

The need for parents of DHH children to receive unbiased information in making informed decisions is well-documented. Unbiased information in this context implies that parents are told about all of the possibilities for communication and language acquisition for their DHH child. However, because cognitive biases are subconscious and difficult to recognise in ourselves, it is possible that “unbiased information” will be provided in a way that could bias parental decision-making. It therefore is important that parents seek out multiple professionals from varying backgrounds/specializations in order to support a more comprehensive view when making decisions.

What we know

Research into decision-making in healthcare settings has identified ways of improving the process for people making health decisions. While many of the decisions that parents make will not be medical per se, the principles still apply in any setting where careful and logical decisions are required. Clinical research indicates that:
  1. Shared decision-making improves everyone’s knowledge about the specific situation, reduces decisional conflict, and improves satisfaction with the decision-making process.
  2. The shared decision-making process involves the clinician sharing the best available evidence about the options available with the family. Parents and clinician then together, consider the child’s values; that is, the benefits and risks of each option that matter most to the child and the family. Finally, parents and clinician reach a shared decision that reflects the child’s preferred option.
  3. Knowledge is central to informed decision-making. Knowledge requires understanding. The information must be clear and jargon-free and help families weigh the benefits and risks of their options. Purely descriptive information about the available options is insufficient for this evaluation process.
  4. Information needs to be balanced and value-neutral in content and presentation to minimise the potential for biasing their thinking.
  5. Testimonials and stories from others are best avoided for preference-sensitive decisions, as they can be misleading if unrepresentative of each option and the possible outcomes associated with those decisions.
  6. Simply telling someone to be aware of their biases is unlikely to be effective as they are primarily subconscious. There is increasing research on reducing bias in health-related judgements and decision-making, and visual aids and decision support tools have shown to be particularly promising.

What we don’t know

It is not apparent in the literature whether the lessons learnt from decision-making in healthcare settings have been implemented in settings where parents of DHH children make decisions. Despite bias being an ongoing concern among those involved in raising and educating deaf children, the cognitive biases of professionals working with these families have not been investigated in the same way as they have within the broader health sector. Each person that the parents visit, including clinicians, audiologists, early interventionists, teachers of the deaf, other parents, and deaf adults can unwittingly bias the parents’ decision-making.

Shared decision-making has been investigated in numerous randomised trials across a variety of medical conditions, but not when parents and clinicians sit down to discuss options for the child who is DHH.

Implications

Providing parents with “unbiased information” does not necessarily lead to an informed or perfect decision. However, shared decision-making and strategies to minimise cognitive biases in professionals and parents have the potential to improve the quality of decisions made by parents, and research directed at these approaches is needed.

Posted on Jan. 31, 2019 by
Ann Porter, Peter Creed, and Michelle Hood
School of Applied Psychology
Griffith University
ann.porter {at} griffithuni.edu.au

 

Further reading