Shared decision-making to improve attention-deficit hyperactivity disorder care

Patient Educ Couns. 2013 Oct;93(1):95-101. doi: 10.1016/j.pec.2013.04.009. Epub 2013 May 10.

Abstract

Objective: To examine the effect of a shared decision-making intervention with parents of children newly diagnosed with attention-deficit/hyperactivity disorder.

Methods: Seven pediatricians participated in a pre/post open trial of decision aids for use before and during the office visit to discuss diagnosis and develop a treatment plan. Encounters pre- (n=21, control group) and post-intervention implementation (n=33, intervention group) were compared. We video-recorded encounters and surveyed parents.

Results: Compared to controls, intervention group parents were more involved in shared decision-making (31.2 vs. 43.8 on OPTION score, p<0.01), more knowledgeable (6.4 vs. 8.1 questions correct, p<0.01), and less conflicted about treatment options (16.2 vs. 10.7 on decisional conflict total score, p=0.06). Visit duration was unchanged (41.0 vs. 41.6min, p=0.75). There were no significant differences in the median number of follow-up visits (0 vs. 1 visits, p=0.08), or the proportion of children with medication titration (62% vs. 76%, p=0.28), or parent-completed behavior rating scale to assess treatment response (24% vs. 39%, p=0.36).

Conclusions: Our intervention increased shared decision-making with parents. Parents were better informed about treatment options without increasing visit duration.

Practice implications: Interventions are available to prepare parents for visits and enable physicians to elicit parent preferences and involvement in decision-making.

Keywords: ADHD; Adherence; Attention-deficit hyperactivity disorder; Decision aids; Family/self-management; SDM; Shared decision-making; attention-deficit hyperactivity disorder; shared decision-making.

Publication types

  • Observational Study
  • Research Support, N.I.H., Extramural
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Attention Deficit Disorder with Hyperactivity / diagnosis*
  • Attention Deficit Disorder with Hyperactivity / therapy
  • Child
  • Decision Making*
  • Decision Support Techniques*
  • Humans
  • Male
  • Middle Aged
  • Ohio
  • Parents / education*
  • Parents / psychology
  • Patient Care Planning*
  • Patient Education as Topic / methods
  • Physicians
  • Practice Patterns, Physicians'
  • Primary Health Care
  • Process Assessment, Health Care
  • Professional-Family Relations*