ABSTRACT
Shared decision making (SDM) is central to patient-centered medicine and has the potential to improve outcomes for pediatric patients with inflammatory bowel diseases. We surveyed specialists about their use of SDM in the decision to start a tumor necrosis factor-α inhibitor in pediatric patients. Results were compared between those who reported using SDM and those who did not. Of 209 respondents, 157 (75%) reported using SDM. Physician/practice characteristics were similar between users and nonusers. There were no statistically significant differences between groups in the components deemed important to the decision-making process nor the number of barriers or facilitators to SDM. Exploratory analyses suggested that physicians using SDM were more accepting of adolescent involvement in the decision-making process. Our results question the effectiveness of using reported barriers and facilitators to guide interventions to improve use of SDM, and suggest further work is needed to understand the adolescent role in decision making.
Subject(s)
Arthritis, Juvenile/drug therapy , Decision Making , Inflammatory Bowel Diseases/drug therapy , Patient Participation , Tumor Necrosis Factor-alpha/therapeutic use , Adolescent , Adult , Aged , Attitude of Health Personnel , Case-Control Studies , Female , Gastroenterology/methods , Humans , Male , Middle Aged , Parents/psychology , Physician-Patient Relations , Rheumatology/methods , Surveys and QuestionnairesABSTRACT
This study assessed pediatric physicians' use of shared decision making (SDM) in 2 chronic conditions. Most physicians indicated that parent and adolescent trust and emotional readiness facilitated SDM, physicians' preferred approach to decision making. At the same time, they perceived few barriers, other than insurance limitations, to using SDM.
Subject(s)
Arthritis, Juvenile/drug therapy , Chronic Disease/therapy , Decision Making , Inflammatory Bowel Diseases/drug therapy , Physicians , Adolescent , Adult , Arthritis, Juvenile/diagnosis , Attitude of Health Personnel , Child , Chronic Disease/economics , Female , Gastroenterology , Humans , Inflammatory Bowel Diseases/diagnosis , Insurance, Health , Male , Middle Aged , Parents , Patient Participation , Pediatrics/methods , Physician-Patient Relations , Rheumatology , Tumor Necrosis Factor-alpha/antagonists & inhibitors , WorkforceABSTRACT
OBJECTIVE: To use observation to understand how decisions about higher-risk treatments, such as biologics, are made in pediatric chronic conditions. METHODS: Gastroenterology and rheumatology providers who prescribe biologics were recruited. Families were recruited when they had an outpatient appointment in which treatment with biologics was likely to be discussed. Consent/assent was obtained to video the visit. Audio of the visits in which a discussion of biologics took place were transcribed and analyzed. Our coding structure was based on prior research, shared decision making (SDM) concepts, and the initial recorded visits. Coded data were analyzed using content analysis and comparison with an existing model of SDM. RESULTS: We recorded 21 visits that included discussions of biologics. In most visits, providers initiated the decision-making discussion. Detailed information was typically given about the provider's preferred option with less information about other options. There was minimal elicitation of preferences, treatment goals, or prior knowledge. Few parents or patients spontaneously stated their preferences or concerns. An implicit or explicit treatment recommendation was given in nearly all visits, although rarely requested. In approximately one-third of the visits, the treatment decision was never made explicit, yet steps were taken to implement the provider's preferred treatment. CONCLUSIONS: We observed limited use of SDM, despite previous research indicating that parents wish to collaborate in decision making. To better achieve SDM in chronic conditions, providers and families need to strive for bidirectional sharing of information and an explicit family role in decision making.