Applying the Flourishing PROM to Paediatric Populations: Key Ethical Considerations

Mr Patrick Ryan5

1The University of Sydney, Camperdown, Australia, 2The Sydney Children’s Hospital Network Clinical Ethics Support Service (SCHNCESS), Westmead, Australia, 3Anne Preisz (Clinical Ethics Lead) – SCHNCESS, Westmead, Australia, 4David Isaacs (Medical lead) – SCHNCESS, Westmead, Australia, 5Tahira Dosani (Clinical Ethic Fellow 2021) – SCHNCESS, Westmead, Australia

Healthcare providers use paediatric PROMs (tools that measure a patient’s wellbeing and health status) and PREMs (tools that measure a patient’s experience in a health setting) to measure health outcomes and facilitate the child’s voice in healthcare interactions. Traditional paediatric PROM tools have focused on evaluating ‘objective’ markers of health, with criteria including pain, function, physical, and psychological status. New paediatric PROM tools, however, are focused on consideration of the ‘subjective’ experiences of children now and into the future; seeking to measure broader wellbeing, social connectedness, and meaning. One such approach includes the ‘Flourishing’ tool, a questionnaire that attempts to evaluate whether the child will have the capacity to ‘flourish’ across a wide range of health and non-health domains. This PROM approach seems ethically relevant as it may better elicit the whole story of the child as they grow and self-actualise. However, we must also consider whether applying the flourishing model in the hospital setting will in practice promote better outcomes for children. In this talk I will focus on:

–              What are the inherent ethical tensions to using the flourishing model on children?

–              Do flourishing models create datasets that can be meaningfully used or create harms related to skews and bias?

Conclusions reached: Flourishing Models advantageously evaluate the ‘whole child’ and their future capacities. However, concerns remain towards:

–              A child’s autonomy and capacity to consent to this toolkit in health settings.

–              The limited capacity to use ‘flourishing’ PROMs and generate datasets for cost-benefit evaluation


Patrick Ryan is a 2nd year medical student at the University of Sydney, and is currently undertaking a clinical ethics program at The Sydney Children’s Hospital Network Clinical Ethics Support Service (SCHNCESS).

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