Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Multicenter Study
. 2011 Nov;165(11):1013-9.
doi: 10.1001/archpediatrics.2011.154.

Physicians' shared decision-making behaviors in attention-deficit/hyperactivity disorder care

William B Brinkman  1 , Jessica Hartl, Lauren M Rawe, Heidi Sucharew, Maria T Britto, Jeffery N Epstein
Affiliations
Multicenter Study

Physicians' shared decision-making behaviors in attention-deficit/hyperactivity disorder care

William B Brinkman et al. Arch Pediatr Adolesc Med. 2011 Nov.

Abstract

Objectives: To describe the amount of shared decision-making (SDM) behavior exhibited during treatment-planning encounters for children newly diagnosed as having attention-deficit/hyperactivity disorder and to explore relationships between participant characteristics and the amount of SDM.

Design: Prospective cohort study.

Setting: Seven community-based primary care pediatric practices in the Cincinnati, Ohio; northern Kentucky; and southeast Indiana regions from October 5, 2009, through August 9, 2010.

Participants: Ten pediatricians and 26 families with a 6- to 10-year-old child newly diagnosed as having attention-deficit/hyperactivity disorder.

Outcome measure: The amount of SDM behavior exhibited during videorecorded encounters, as coded by 2 independent raters using the validated Observing Patient Involvement (OPTION) scale, which was adapted for use in pediatric settings and produces a score ranging from 0 (no parental involvement) to 100 (maximal parental involvement).

Results: Treatment decisions focused on initiation of medication treatment. The mean (SD) total OPTION score was 28.5 (11.7). More SDM was observed during encounters involving families with white vs nonwhite children (adjusted mean difference score, 14.9; 95% confidence interval [CI], 10.2-19.6; P < .001), private vs public health insurance coverage (adjusted mean difference score, 15.1; 11.2-19.0; P < .001), mothers with at least some college education vs high school graduate or less (adjusted mean difference score, 12.3; 7.2-17.4; P < .001), and parents who did not screen positive for serious mental illness vs those who did (adjusted mean difference score, 15.0; 11.9-18.1; P < .001).

Conclusions: Low levels of SDM were observed. Exploratory analyses identified potential disparities and barriers. Interventions may be needed to foster SDM with all parents, especially those of nonwhite race, of lower socioeconomic status, of lower educational level, and with serious mental illness.

PubMed Disclaimer

Figures

Figure
Figure. Boxplots of OPTION scale items and item-level reliability
middle line in box=median, sides of box=25th and 75th percentiles, whiskers=min and max values; scale from 0–4, with zero indicating that behavior was not observed and four indicating that behavior was exhibited to a high standard.
See this image and copyright information in PMC

References

    1. IOM. Crossing the Quality Chasm: A New Health System foe the 21st Century. Washington D.C: National Academy Press; 2001. - PubMed
    1. IOM. Initial Research Priorities for Comparative Effectiveness Research. Washington D. C: National Academy Press; 2009.
    1. Family-centered care and the pediatrician's role. Pediatrics. 2003 Sep;112(3 Pt 1):691–697. - PubMed
    1. O'Connor AM, Llewellyn-Thomas HA, Flood AB. Modifying unwarranted variations in health care: shared decision making using patient decision aids. Health Aff (Millwood) 2004 Suppl Web Exclusive:VAR63–72. - PubMed
    1. Zito JM, Safer DJ, dosReis S, Magder LS, Gardner JF, Zarin DA. Psychotherapeutic medication patterns for youths with attention-deficit/hyperactivity disorder. Arch Pediatr Adolesc Med. 1999 Dec;153(12):1257–1263. - PubMed

Publication types