An adolescent patient with terminal cancer tells the nurse that she does not want to continue treatment, even though her parents are planning for her to participate in a study trial that involves aggressive chemotherapy. Which action by the nurse is the most appropriate?

• A. Notify the adolescent that she can make her own decisions no matter what her parents want.
• B. Request that the parents and daughter meet together with the health-care team to discuss options and the implications of various choices.
• C. Tell her not to worry, that she knows her parents want the best for her.
• D. Tell the patient that the decision is her parents' and she has to participate in the study.

Answer: (B)

This situation tests how to handle adolescent autonomy versus parental input in treatment decisions, emphasizing shared decision-making and informed assent in pediatric care.

The best action is to arrange a meeting with the adolescent, her parents, and the health-care team to discuss options and the implications. This approach respects the patient’s emerging autonomy by including her in the conversation, ensures that she understands the potential benefits, risks, and burdens of continuing aggressive chemo, and clarifies goals of care in the context of terminal illness. It also allows the team to assess her understanding and capacity to participate in decisions, while giving parents the opportunity to share their concerns and values. A joint discussion supports aligned, patient-centered choices and helps resolve the disagreement through collaboration rather than coercion.

Options that imply the patient can decide independently of her parents or that the decision rests solely with the parents bypass the need for collaborative deliberation and fail to acknowledge the adolescent’s role in assent. Dismissing her concerns or telling her not to worry also undermines trust and the ethical process of informed, shared decision-making.