*This recording is repurposed from the 2023 Annual Assembly

Children with medical complexity (CMC), who have chronic conditions, high healthcare utilization, and use medical technology, are increasingly being referred to palliative care for decision support. However, their complexity creates a decision-making paradox: we make decisions by choosing between imagined futures, but the defining characteristic of complex systems is the unpredictability of future outcomes. How do we help families navigate decisions when we are unable to confidently predict what might happen with different options? Anchored by a case about a family deciding about scoliosis surgery for their daughter with severe neurologic impairment, this session will integrate ideas from psychology and business to describe the use of narrative as a decision-making tool.

Pre-decision narratives can facilitate conversations about the influence of complexity on outcomes and can help families intentionally craft their own post-decision narrative before the decision is made. Clinicians can use post-decision narrative before the decision to identify their own blind spots, which may enhance their cultural humility. Many of these strategies are used intuitively by expert clinicians—this session provides a framework so that they can be wielded more intentionally and explained to learners. Though discussed with a pediatric lens, introduced concepts are applicable across the lifespan.