Contrasting parents' and pediatricians' perspectives on shared decision-making in ADHD.

TitleContrasting parents' and pediatricians' perspectives on shared decision-making in ADHD.
Publication TypeJournal Article
Year of Publication2011
AuthorsFiks AG, Hughes CC, Gafen A, Guevara JP, Barg FK
JournalPediatrics
Volume127
Issue1
Paginatione188-96
Date Published2011 Jan
ISSN1098-4275
KeywordsAttention Deficit Disorder with Hyperactivity, Child, Consumer Participation, Decision Making, Female, Humans, Male, Parents, Pediatrics
Abstract

OBJECTIVE: The goal was to compare how parents and clinicians understand shared decision-making (SDM) in attention-deficit/hyperactivity disorder (ADHD), a prototype for SDM in pediatrics.

METHODS: We conducted semi-structured interviews with 60 parents of children 6 to 12 years of age with ADHD (50% black and 43% college educated) and 30 primary care clinicians with varying experience. Open-ended interviews explored how pediatric clinicians and parents understood SDM in ADHD. Interviews were taped, transcribed, and then coded. Data were analyzed by using a modified grounded theory approach.

RESULTS: Parents and clinicians both viewed SDM favorably. However, parents described SDM as a partnership between equals, with physicians providing medical expertise and the family contributing in-depth knowledge of the child. In contrast, clinicians understood SDM as a means to encourage families to accept clinicians' preferred treatment. These findings affected care because parents mistrusted clinicians whose presentation they perceived as biased. Both groups discussed how real-world barriers limit the consideration of evidence-based options, and they emphasized the importance of engaging professionals, family members, and/or friends in SDM. Although primary themes did not differ according to race, white parents more commonly received support from medical professionals in their social networks.

CONCLUSIONS: Despite national guidelines prioritizing SDM in ADHD, challenges to implementing the process persist. Results suggest that, to support SDM in ADHD, modifications are needed at the practice and policy levels, including clinician training, incorporation of decision aids and improved strategies to facilitate communication, and efforts to ensure that evidence-based treatment is accessible.

DOI10.1542/peds.2010-1510
Alternate JournalPediatrics
PubMed ID21172996
PubMed Central IDPMC3010085
Grant List1K23HD059919 / HD / NICHD NIH HHS / United States