Shared decision-making (SDM) is a process in which health care professionals (HCPs) involve parents and children - when appropriate- to decide together on future treatment. These decisions are based on values that are important for the family, goals of care and preferences for future care and treatment. Elucidation of these values and preferences is preferably done early in the disease trajectory via so-called Advance Care Planning (ACP) conversations.

In the Netherlands, ACP and SDM are being adopted by most health care professionals. This has happened only recently. Ten years ago, ACP and SDM were unknown concepts for the vast majority of Dutch HCPs. Today, interest in these conversational approaches is booming in both daily practice and in research.

This rise has been reinforced by two recent major advancements in Dutch pediatric palliative care: the Individual Care Plan (ICP) and the Dutch Evidence-Based Guideline on Pediatric Palliative Care (DGPPC).

Despite this positive evolution, a lot of work is still ahead. ACP and SDM demand a change in mindset from the traditional paternalistic approach by which the HCP ‘knows what is best for this child’ to a more humble and open approach in which (non-medical) factors that are important to the child and family and may influence the final treatment decision. Such changes in mindset don't happen overnight.

In this article we describe the situation of pediatric palliative care in the Netherlands, with focus on the recent evolution of ACP and SDM.

共同决策 (SDM) 是一个由医疗保健专业人员 (HCP) 让父母和儿童（在适当的情况下）参与共同决定未来治疗的过程。这些决定基于对家庭重要的价值观、护理目标以及对未来护理和治疗的偏好。优选地在疾病轨迹的早期通过所谓的预先护理计划（ACP）对话来阐明这些价值观和偏好。

在荷兰，大多数医疗保健专业人员正在采用 ACP 和 SDM。这只是最近才发生的。十年前，ACP 和 SDM 对于绝大多数荷兰 HCP 来说还是未知的概念。如今，人们对这些对话方法的兴趣在日常实践和研究中都在蓬勃发展。

荷兰儿科姑息治疗最近的两项重大进展进一步强化了这一增长：个人护理计划 (ICP) 和荷兰儿科姑息治疗循证指南 (DGPPC)。

尽管取得了积极的进展，但仍有大量工作要做。ACP 和 SDM 要求改变观念，从传统的家长式做法（HCP“知道什么对这个孩子最好”）转变为更加谦虚和开放的做法，其中对儿童和家庭重要的（非医疗）因素和可能会影响最终的治疗决定。这种心态的改变不是一朝一夕就能发生的。

在本文中，我们描述了荷兰儿科姑息治疗的情况，重点关注 ACP 和 SDM 的最新发展。