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Adolescents’ Capacity to Make Decisions in Healthcare: Perspectives of Serbian Primary Care Physicians

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Abstract

Allowing competent children to exercise their right to consent relies largely on healthcare practitioners’ own understanding and attitudes regarding the maturity and decision-making capacity of minor patients, particularly in circumstances when professional guidelines for practice do not exist. The aim of this study was to explore Serbian primary care physicians’ a) views and experiences regarding decision-making capacity of adolescents, b) experiences with adolescents’ parents regarding their children’s right to give autonomous consent and c) views on their own role in adolescents’ healthcare. Qualitative semi-structured interviews were conducted in person with twelve pediatricians and gynecologists at eight primary health care institutions at Belgrade (Serbia) from March to May 2016. Qualitative content analysis was used to identify categories in the data. Participants agreed that decision-making capacity is reached at an individual pace, making it difficult to set age boundaries for consent. However, they noted that adolescents’ decision-making capacity can be enhanced by providing appropriate support, by both physicians and parents. Participants described witnessing overprotective behavior in parents, yet highlighted that physicians are well placed to help parents understand the importance of letting their adolescent children participate in decision-making. Since participation in decision-making is considered to be in the best interest of minors, primary care physicians can be important agents in strengthening adolescents’ positions as decision-makers in healthcare. In addition, healthcare workers would benefit from additional training in skills to enhance communication with both adolescents and parents.

Highlights

  • Adolescents need to be encouraged and assisted in the development of their decisional capacity and autonomy.

  • Parents need to be educated on the importance of adolescents’ right to participation in health care decision-making.

  • Cultural values and inter-familial relations need to be taken into account when deciding on the level of children’s autonomy.

  • Primary care physicians would benefit from additional training in adolescent medicine and skills for communication with both adolescents and parents.

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Data availability

The data that support the findings of this study are available on request from the corresponding author.

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Acknowledgements

We would like to show our gratitude to Danka Sinadinovic who provided expertise in verifying translations of original quotes. Danya Vears acknowledges the infrastructure funding received from the Victorian State Government through the Operational Infrastructure Support (OIS) Program. This work was supported by the Australian Government through the Medical Research Future Fund, as part of the Genomics Health Futures Mission (Grant number 76749).

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Authors and Affiliations

  1. Department of Humanities, Faculty of Medicine, University of Belgrade, Pasterova 2, 11000, Belgrade, Serbia

    Vida Jeremic Stojkovic, Karel Turza & Smiljana Cvjetkovic

  2. Murdoch Children’s Research Institute, 50 Flemington Road, Parkville, VIC, 3052, Australia

    Danya F. Vears

  3. Melbourne Law School, University of Melbourne, 185 Pelham Street, Carlton, VIC, 3053, Australia

    Danya F. Vears

  4. Center for Biomedical Ethics and Law, Department of Public Health and Primary Care, KU Leuven, Kapucijnenvoer 35, 3000, Leuven, Belgium

    Danya F. Vears

  5. Institute of Social Medicine, Faculty of Medicine, University of Belgrade, Dr Subotica 5, 11000, Belgrade, Serbia

    Bojana Matejic

  6. Institute of Epidemiology, Faculty of Medicine, University of Belgrade, Visegradska 26, 11000, Belgrade, Serbia

    Tatjana Gazibara

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  1. Vida Jeremic Stojkovic
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  2. Danya F. Vears
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  3. Bojana Matejic
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  4. Tatjana Gazibara
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  5. Karel Turza
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  6. Smiljana Cvjetkovic
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Contributions

Conceptualization: V.J.S., D.V., T.G. Methodology: V.J.S., D.V., T.G.; Formal analysis and investigation: V.J.S., B.M., K.T.. Writing – original draft preparation: V.J.S. Writing – review and editing: D.V., B.M., T.G., K.T., S.C.

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Correspondence to Vida Jeremic Stojkovic.

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The authors declare no competing interests.

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This study was performed in line with the principles of the Declaration of Helsinki. Study protocol was approved by the Ethics Committee of the Faculty of Medicine, University of Belgrade (approval number: 29/VI-1).

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Informed consent was obtained from all individual participants included in the study.

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Jeremic Stojkovic, V., Vears, D.F., Matejic, B. et al. Adolescents’ Capacity to Make Decisions in Healthcare: Perspectives of Serbian Primary Care Physicians. J Child Fam Stud 31, 3268–3280 (2022). https://doi.org/10.1007/s10826-022-02365-3

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