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Interventions are needed to effectively train HCPs in the delivery of shared decision-making, and to support the participation of adolescents with LTCs in shared decision-making.

Adolescents living with long-term conditions (LTCs) often feel as though they are left out of discussions and decisions with healthcare professionals, which can give them the impression that their views are not important. Research around decision-making during clinical encounters often fails to represent adolescents' perspectives. This study explores adolescents' perceptions and experiences, focusing on identifying the perceived barriers to, and facilitators for, their involvement in shared decision-making. Methods Nineteen adolescents (13-19 years) with LTCs were recruited from endocrinology, rheumatology, neurology and nephrology clinics. Participatory qualitative interviews were conducted using life grids and pie charts, and transcripts were analysed thematically. Results Four overarching themes and nine sub-themes were identified which describe barriers and facilitators around shared decision-making. Adolescents need to feel as though their involvement is supported by parents and healthcare professionals, that their contribution to the decision-making process is important, and will yield a positive outcome. Adolescents often feel it is their right to be involved in decisions that affect them, but also feel as though the adults' contributions to the decisions are considered more valuable. Adolescents need to feel capable of being involved, in terms of being able to understand and process information about the available options, and ask appropriate questions. Conclusions This work highlights a number of ways shared decision-making can be facilitated between healthcare practitioners and adolescents with LTCs. Identifying the needs of adolescents with LTCs is necessary for optimising the SDM process and to support them during healthcare consultations.