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

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

William B Brinkman  1 , Jessica Hartl Majcher, Lauren M Poling, Gaoyan Shi, Mike Zender, Heidi Sucharew, Maria T Britto, Jeffery N Epstein
Affiliations
Observational Study

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

William B Brinkman et al. Patient Educ Couns. 2013 Oct.

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.

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Conflict of interest statement

Conflict of interest

The authors of this article disclose no financial conflicts of interest pertinent to this study. In particular, the intervention materials described in this article are available in the public domain free of charge at: http://www.cincinnatichildrens.org/shareddecisions.

Figures

Fig. 1
Fig. 1
The ADHD medication choice cards. Reproduced with permission from the Cincinnati Children’s Hospital Medical Center Research Foundation.
See this image and copyright information in PMC

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