A Learning Loop Model of Collaborative Decision-Making in Chronic Illness

Sarah D. Ronis, Lawrence C. Kleinman, Kurt C. Stange

Research output: Contribution to journalArticlepeer-review

4 Scopus citations


Shared decision-making is a core attribute of quality health care that has proved challenging to implement and assess in pediatric practice. Current models of shared decision-making are limited, including their capacity to incorporate multiple stakeholders; to integrate downstream effects of subacute or minor decisions; and to account for the context(s) in which such decisions are being made and enacted. Based on a review of literature from organizational psychology, cognitive sciences, business, and medicine, we propose an iterative decision-making model of care planning and identify targets at several levels of influence warranting measurement in future studies. Our learning loop model posits the relationship between pediatric patients, their parents, and their clinicians as central to the collaborative decision-making process in the setting of chronic illness. The model incorporates the evolution of both context and developmental capacity over time. It suggests that “meta-learning” from the experience of and outcomes from iterative decision is a key factor that may influence relationships and thus continued engagement in collaboration by patients, their parents, and their clinicians. We consider the model in light of the needs of children with special health care needs, for whom understanding the ongoing iterative effects of decision making and clinician−parent−child dynamics are likely to be particularly important in influencing outcomes.

Original languageEnglish (US)
Pages (from-to)497-503
Number of pages7
JournalAcademic pediatrics
Issue number5
StatePublished - Jul 2019

All Science Journal Classification (ASJC) codes

  • Pediatrics, Perinatology, and Child Health


  • care planning
  • children with special health care needs
  • collaborative decision-making
  • doctor−patient relationship
  • family-centered care

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