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

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.