Shared decision-making in pediatrics: a national perspective.

TitleShared decision-making in pediatrics: a national perspective.
Publication TypeJournal Article
Year of Publication2010
AuthorsFiks AG, A Localio R, Alessandrini EA, Asch DA, Guevara JP
JournalPediatrics
Volume126
Issue2
Pagination306-14
Date Published2010 Aug
ISSN1098-4275
KeywordsAsthma, Attention Deficit Disorder with Hyperactivity, Child, Child, Preschool, Communication, Comorbidity, Cooperative Behavior, Cross-Sectional Studies, Decision Making, Organizational, Female, Humans, Incidence, Male, Pediatrics, Prevalence, Professional-Family Relations, Questionnaires, United States
Abstract

OBJECTIVES: To identify patterns of shared decision-making (SDM) among a nationally representative sample of US children with attention-deficit/hyperactivity disorder (ADHD) or asthma and determine if demographics, health status, or access to care are associated with SDM.

PATIENTS AND METHODS: We performed a cross-sectional study of the 2002-2006 Medical Expenditure Panel Survey, which represents 2 million children with ADHD and 4 million children with asthma. The outcome, high SDM, was defined by using latent class models based on 7 Medical Expenditure Panel Survey items addressing aspects of SDM. We entered factors potentially associated with SDM into logistic regression models with high SDM as the outcome. Marginal standardization then described the standardized proportion of children's households with high SDM for each factor.

RESULTS: For both ADHD and asthma, 65% of children's households had high SDM. Those who reported poor general health for their children were 13% less likely to have high SDM for ADHD (64 vs 77%) and 8% less likely for asthma (62 vs 70%) when adjusting for other factors. Results for behavioral impairment were similar. Respondent demographic characteristics were not associated with SDM. Those with difficulty contacting their clinician by telephone were 26% (ADHD: 55 vs 81%) and 29% (asthma: 48 vs 77%) less likely to have high SDM than those without difficulty.

CONCLUSIONS: These findings indicate that households of children who report greater impairment or difficulty contacting their clinician by telephone are less likely to fully participate in SDM. Future research should examine how strategies to foster ongoing communication between families and clinicians affect SDM.

DOI10.1542/peds.2010-0526
Alternate JournalPediatrics
PubMed ID20624804
PubMed Central IDPMC3373306
Grant ListK23 HD059919 / HD / NICHD NIH HHS / United States
K23 HD059919-03 / HD / NICHD NIH HHS / United States
K23HD059919 / HD / NICHD NIH HHS / United States