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Kindratt TB, Lark P, Ray M, Brannon GE. Disparities in Patient- and Family-Centered Care Among Children With Health Conditions. J Patient Exp 2022; 9:23743735221092494. [PMID: 35450089 PMCID: PMC9016532 DOI: 10.1177/23743735221092494] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
The objective of this study was to estimate and compare the prevalence of patient- and family-centered cae (PFCC) received by children in the United States (US) with chronic and developmental health conditions and determine associations between the presence of the conditions and parents' perceptions of PFCC after controlling for covariates. Linked data from the 2012-2016 National Health Interview Survey (NHIS) and 2013-2017 Medical Expenditure Panel Survey (MEPS) (n = 7,835) were tested using crude and adjusted logistic regression procedures. Parents of children with developmental delays had 32% lower odds (95% CI = 0.51-0.90) of reporting their healthcare provider always exhibited all PFCC qualities. Parents of children with allergies and developmental delays had 26% (95% CI = 0.58-0.95) and 42% (95% CI = 0.42-0.80) lower odds of reporting their provider always listened carefully compared to parents whose children did not. Findings demonstrate the importance of continuous training for providers to tailor communication for families who have children with health conditions.
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Affiliation(s)
- Tiffany B Kindratt
- Public Health Program, Department of Kinesiology, College of Nursing
and Health Innovation, University of Texas at
Arlington, Arlington, TX, USA
| | - Payton Lark
- Public Health Program, Department of Kinesiology, College of Nursing
and Health Innovation, University of Texas at
Arlington, Arlington, TX, USA
| | - Madison Ray
- Department of Communication, College of Liberal Arts, University of Texas at
Arlington, Arlington, TX, USA
| | - Grace Ellen Brannon
- Department of Communication, College of Liberal Arts, University of Texas at
Arlington, Arlington, TX, USA
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2
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Zerbe PS, Schulz E, Dixius A, Körner M. [The desire and the experience of participation among children and adolescents in inpatient mental healthcare]. ZEITSCHRIFT FUR KINDER-UND JUGENDPSYCHIATRIE UND PSYCHOTHERAPIE 2021; 49:213-226. [PMID: 33993737 DOI: 10.1024/1422-4917/a000797] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
The desire and the experience of participation among children and adolescents in inpatient mental healthcare Abstract. Objective: Children have the right to participate in decisions that affect them. However, the stages and domains of participation relevant within inpatient child and adolescent psychiatry have rarely been empirically investigated. The present study closes this research gap. Method: A prospective, multicenter, questionnaire-based survey was conducted. The questionnaire comprised 100 items, summarized in 16 scales, to assess the desire and the experience of participation. The data were quantitively evaluated. Results: 81 children and adolescents from 5 psychiatric hospitals took part in the study. Overall, they wished more participation than experienced. The higher the level of participation, the greater the difference was between wish and reality. The desire for participation is particularly high for decisions regarding communication with family and friends. The largest difference between desire and experience related to respectful and trusting interaction with patients, and for female patients, this difference was even higher. Conclusion: Participation means more than informed consent. There is still potential for expanding participation in child and adolescent psychiatry, especially at higher levels of participation and concerning decisions about communication with family and friends. A respectful and trusting interaction with patients, regardless of age, sex, or illness, is fundamental.
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Affiliation(s)
- Paul-Simon Zerbe
- Klinik für Psychiatrie, Psychotherapie und Psychosomatik im Kindes- und Jugendalter, Universitätsklinikum Freiburg.,Institut für Medizinische Psychologie und Medizinische Soziologie, Albert-Ludwigs-Universität Freiburg
| | - Eberhard Schulz
- Klinik für Psychiatrie, Psychotherapie und Psychosomatik im Kindes- und Jugendalter, Universitätsklinikum Freiburg
| | - Andrea Dixius
- Psychotherapie und Psychosomatik, SHG Kliniken für Kinder- und Jugendpsychiatrie, Kleinblittersdorf
| | - Mirjam Körner
- Institut für Medizinische Psychologie und Medizinische Soziologie, Albert-Ludwigs-Universität Freiburg
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3
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Partizipation von Patienten im Kontext der stationären Kinder- und Jugendpsychiatrie – ein Scoping Review. Prax Kinderpsychol Kinderpsychiatr 2020; 69:700-719. [DOI: 10.13109/prkk.2020.69.8.700] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Decision Making in Pediatric Plastic Surgery: Autonomy and Shared Approaches. J Craniofac Surg 2020; 31:2139-2143. [PMID: 33136843 DOI: 10.1097/scs.0000000000006738] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND Although shared decision-making is essential to patient-centered healthcare, its role in pediatric plastic surgery remains unclear. The objective of this study was to define the preferred level of involvement in surgical decision-making among children, caregivers, and surgeons. METHODS The authors surveyed pediatric plastic surgery patients (n = 100) and their caregivers regarding their preferences on child involvement during surgical decision-making. Fleiss' kappa was used to assess agreement between groups. Bivariate Chi-square tests and multinomial logistic regression were used to assess the relationship between decision-making preferences and select demographic factors. RESULTS Only 34% of children and their caregivers agreed upon their decision-making preferences (k = 0.04). The majority of children (40%) and caregivers (67%) favored shared decision-making between the patient, caregiver, and surgeon. Only 16% of children preferred physician-driven decisions, while 20% of children desired complete autonomy. Children's preferences were significantly associated with their age; the relative risk of children deferring to caregivers or surgeons over a shared approach was lower for adolescents and teens compared to children under 10 years old (relative risk = 0.20; 95% confidence interval: 0.054-0.751; P = 0.02). Caregiver's preferences did not change based on the child's age, but rather were related to the child's gender. Caregivers were more likely to choose the option that gave the child more autonomy when the child was male. CONCLUSIONS While most caregivers preferred a shared approach to decision-making, children desired greater autonomy, particularly with increasing age. Since there was limited agreement between caregivers and children, surgeons must be cognizant of differing preferences when discussing treatment plans to optimize both patient and parent satisfaction.
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Milky G, Thomas J. Shared decision making, satisfaction with care and medication adherence among patients with diabetes. PATIENT EDUCATION AND COUNSELING 2020; 103:661-669. [PMID: 31676101 DOI: 10.1016/j.pec.2019.10.008] [Citation(s) in RCA: 53] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/15/2019] [Revised: 10/10/2019] [Accepted: 10/12/2019] [Indexed: 06/10/2023]
Abstract
OBJECTIVES We examined factors associated with shared decision making and whether shared decision-making (SDM) was associated with satisfaction with care or with adherence to anti-diabetic medication. METHODS A retrospective study was conducted using 2011-2014 Medical Expenditure Panel Survey (MEPS) data. Inclusion criteria were 18 years or older and visit to a usual source of care during the prior 12 months. Exclusion criteria were reported cognitive limitation, proxy response, less than two prescription fills, or missing data on study variables. SDM was assessed using seven MEPS items. Satisfaction with care was assessed using a single MEPS item 12 months after SDM measurement. Adherence was assessed using Medication Possession Ratio in 12 months after SDM measurement. RESULTS The weighted sample of 797 respondents represented 15.6 million with diabetes. Being older, male, or uninsured were associated with low SDM. High SDM was associated with higher satisfaction (p < 0.0001). SDM was not associated with adherence. CONCLUSIONS Patients with higher SDM were more satisfied with their healthcare. We did not find association between SDM and adherence to antidiabetic medication. PRACTICE IMPLICATIONS Involvement in SDM is encouraged to improve patient satisfaction. Providers may consider age, sex and insurance status in facilitating communications to improve SDM.
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Affiliation(s)
- Gediwon Milky
- Department of Pharmacy Practice, Purdue University, West Lafayette, IN, USA
| | - Joseph Thomas
- Department of Pharmacy Practice, Purdue University, West Lafayette, IN, USA.
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Kamimura-Nishimura KI, Brinkman WB, Froehlich TE. Strategies for improving ADHD medication adherence. CURRENT PSYCHIATRY 2019; 18:25-38. [PMID: 33867872 PMCID: PMC8049396] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
To maximize outcomes, understand and address the factors that affect adherence.
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Affiliation(s)
| | | | - Tanya E Froehlich
- Department of Pediatrics, Division of Developmental and Behavioral Pediatrics, Cincinnati Children's Hospital Medical Center, University of Cincinnati, Cincinnati, Ohio
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7
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Jolles MP, Lee PJ, Javier JR. Shared decision-making and parental experiences with health services to meet their child's special health care needs: Racial and ethnic disparities. PATIENT EDUCATION AND COUNSELING 2018; 101:1753-1760. [PMID: 29884531 DOI: 10.1016/j.pec.2018.05.022] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/09/2018] [Revised: 04/20/2018] [Accepted: 05/26/2018] [Indexed: 06/08/2023]
Abstract
OBJECTIVES Test the relationship between shared decision-making (SDM) and parental report of frustration with efforts to get services for their child and to address unmet health needs; assess SDM's influence on minority parents' service experiences. METHODS Performed secondary analysis using the 2009-2010 National Survey of Children with Special Health Care Needs (n = 40,242). Used multivariate logistic regressions to test the association between SDM and parent-reported service experiences, and whether SDM influenced the association between minorities and negative service experiences. Propensity scores accounted for observed selection bias. RESULTS Families engaged in SDM had lower odds of reporting service dissatisfaction. Fewer minority parents reported SDM engagement compared with Whites (between 62% and 66% versus 74%). Blacks engaged in SDM had higher odds of reporting negative service experiences compared with SDM-engaged Whites. This disparity was no longer significant after adjusting for covariates. CONCLUSION SDM is associated with lower reports of parental service dissatisfaction. Stratified analyses showed that SDM seems to be experienced differently across minority groups. PRACTICE IMPLICATIONS SDM may be a promising engagement strategy to improve parental service experiences. The role of SDM on increasing Black parents' reports of service dissatisfaction, perhaps due to increased awareness of service challenges, should be investigated.
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Affiliation(s)
- Mónica Pérez Jolles
- Suzanne Dworak-Peck School of Social Work, Gehr Family Center for Health Systems Science, University of Southern California, Los Angeles.
| | - Pey-Jiuan Lee
- Suzanne Dworak-Peck School of Social Work, University of Southern California, Los Angeles.
| | - Joyce R Javier
- Division of General Pediatrics, Department of Pediatrics Children's Hospital Los Angeles, USC Keck School of Medicine.
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McKenzie RB, Sanders L, Bhattacharya J, Bundorf MK. Health Care System Factors Associated with Transition Preparation in Youth with Special Health Care Needs. Popul Health Manag 2018; 22:63-73. [PMID: 29957127 DOI: 10.1089/pop.2018.0027] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
The aim of this study was to assess: (1) the proportion of youth with special health care needs (YSHCN) with adequate transition preparation, (2) whether transition preparation differs by individual, condition-related and health care system-related factors, and (3) whether specific components of the medical home are associated with adequate transition preparation. The authors conducted a cross-sectional analysis of the 2009-2010 National Survey of Children with Special Health Care Needs, which surveyed a nationally representative sample of 17,114 parents of YSHCN ages 12 to 18 years. Adequate transition preparation was based on positive responses to questions about transition to an adult provider, changing health care needs, maintaining insurance coverage, and if providers encouraged YSHCN to take responsibility for health care needs. Weighted descriptive, bivariate and multivariate analyses were conducted to determine the association between patient and health care system factors and adequate transition preparation. Overall, 32.1% of YSHCN had adequate transition preparation. Older age, female sex, income ≤400% of the poverty level, lack of medical complexity, and having shared decision making, family-centered care, and effective care coordination were associated with increased odds of transition preparation. The majority of YSHCN do not receive adequate transition preparation and younger, male adolescents with medical complexity were less likely to receive transition preparation. Different patterns of disparities were identified for each subcomponent measure of transition preparation, which may help target at-risk populations for specific services. Efforts to improve transition preparation should leverage specific components of the medical home including care coordination, shared decision making, and family-centered care.
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Affiliation(s)
| | - Lee Sanders
- 2 Division of General Pediatrics, Stanford University , Stanford, California
| | - Jay Bhattacharya
- 1 Division of Pediatric Gastroenterology, Stanford University , Stanford, California.,3 Center for Primary Care and Outcomes Research, Department of Medicine, Stanford University , Stanford, California
| | - M Kate Bundorf
- 4 Department of Health Research and Policy, Stanford University , Stanford, California
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9
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Levy SE, Fiks AG. Shared Decision Making for Children With Developmental Disorders: Recent Advances. Acad Pediatr 2018; 18:364-365. [PMID: 29432908 DOI: 10.1016/j.acap.2018.02.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2018] [Revised: 01/20/2018] [Accepted: 02/03/2018] [Indexed: 11/25/2022]
Affiliation(s)
- Susan E Levy
- Center for Autism Research, The Children's Hospital of Philadelphia, Perelman School of Medicine at University of Pennsylvania, Roberts Center for Research, Philadelphia, Pa.
| | - Alexander G Fiks
- Policy Lab, The Children's Hospital of Philadelphia, Perelman School of Medicine at University of Pennsylvania, Roberts Center for Research, Philadelphia, Pa
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10
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Lin JL, Cohen E, Sanders LM. Shared Decision Making among Children with Medical Complexity: Results from a Population-Based Survey. J Pediatr 2018; 192:216-222. [PMID: 29102046 PMCID: PMC5732902 DOI: 10.1016/j.jpeds.2017.09.001] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2017] [Revised: 07/20/2017] [Accepted: 09/01/2017] [Indexed: 02/06/2023]
Abstract
OBJECTIVE To compare the rates of shared decision making (SDM) reported by parents of children with medical complexity (CMC) with the rates of SDM reported by parents of noncomplex children with special health care needs (CSHCN). STUDY DESIGN We examined the 2009-2010 National Survey of Children with Special Health Care Needs, a representative survey of 40 242 parents of CSHCN. CMC was defined as needing or using more medical care than usual, seeing 2 or more subspecialists, and positive response on at least 3 other items on the CSHCN screener. We identified 3 subgroups each of CMC and noncomplex CSHCN by sentinel diagnoses: asthma, seizures, and other diagnoses. SDM was defined as a binary composite variable, derived from 4 discrete items. We constructed 4 stepwise multivariable models to assess the relative odds of SDM, adjusted for sociodemographic characteristics (age, income, language, race, ethnicity, and marital status), behavioral comorbidity, family-centered care, and patient-centered medical home. RESULTS The study population included 39 876 respondents. Compared with noncomplex CSHCN, CMC had a lower likelihood of SDM (aOR, 0.76; 95% CI, 0.64-0.91), which persisted in diagnostic subgroups: CMC with asthma (aOR, 0.67; 95% CI, 0.49-0.92) and CMC with other diagnoses (aOR, 0.74; 95% CI, 0.58-0.94), but not CMC with seizures (aOR, 0.95; 95% CI, 0.59-1.51). CONCLUSIONS SDM is less common for CSHCN with complex needs than those without complex needs. Health system interventions targeting future-oriented care planning may improve SDM for CMC.
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Affiliation(s)
- Jody L Lin
- Division of Pediatric Hospital Medicine, Stanford University, Department of Pediatrics, Palo Alto, CA.
| | - Eyal Cohen
- Division of Pediatric Medicine, Hospital for Sick Children, Department of Pediatrics and Institute of Health Policy, Management, and Evaluation, University of Toronto
| | - Lee M Sanders
- Division of General Pediatrics, Stanford University, Department of Pediatrics
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11
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Adams RC, Levy SE. Shared Decision-Making and Children With Disabilities: Pathways to Consensus. Pediatrics 2017; 139:peds.2017-0956. [PMID: 28562298 DOI: 10.1542/peds.2017-0956] [Citation(s) in RCA: 100] [Impact Index Per Article: 14.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Shared decision-making (SDM) promotes family and clinician collaboration, with ultimate goals of improved health and satisfaction. This clinical report provides a basis for a systematic approach to the implementation of SDM by clinicians for children with disabilities. Often in the discussion of treatment plans, there are gaps between the child's/family's values, priorities, and understanding of perceived "best choices" and those of the clinician. When conducted well, SDM affords an appropriate balance incorporating voices of all stakeholders, ultimately supporting both the child/family and clinician. With increasing knowledge of and functional use of SDM skills, the clinician will become an effective partner in the decision-making process with families, providing family-centered care. The outcome of the process will support the beneficence of the physician, the authority of the family, and the autonomy and well-being of the child.
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Affiliation(s)
- Richard C. Adams
- aUniversity of Texas Southwestern Medical Center, Texas Scottish Rite Hospital for Children, Dallas, Texas
| | - Susan E. Levy
- bCenter for Autism Research, Division Developmental and Behavioral Pediatrics, The Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania
- cPerelman School of Medicine at University of Pennsylvania, Philadelphia, Pennsylvania
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12
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Butler AM, Weller B, Titus C. Relationships of Shared Decision Making with Parental Perceptions of Child Mental Health Functioning and Care. ADMINISTRATION AND POLICY IN MENTAL HEALTH AND MENTAL HEALTH SERVICES RESEARCH 2016; 42:767-74. [PMID: 25577238 DOI: 10.1007/s10488-014-0612-y] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Experts encourage parents and practitioners to engage in shared decision making (SDM) to provide high quality child mental health care. However, little is known regarding SDM among families of children with common mental health conditions. The objectives of this study were to examine associations between parental report of SDM and parental perceptions of (a) receiving child mental health care and (b) child mental health functioning. We analyzed cross-sectional data on children with a common mental health condition (attention-deficit hyperactivity disorder, oppositional-defiant or conduct disorder, anxiety, or depression) from the 2009/2010 National Survey of Children with Special Healthcare Needs (N = 9,434). The primary independent variable was parent-reported SDM, and the dependent variables were parental perception of (a) their child receiving all needed mental health care (b) their children's impairment in school attendance and extracurricular activity participation, and (c) severity of their children's mental health condition. Multivariate logistic and multinomial regression analyses were conducted. Greater parent-reported SDM was associated with parental perceptions of receiving all needed child mental health care and children not having school or extracurricular impairment. Greater SDM was also associated with perceptions of children having a mild mental health condition compared to children having a moderate or severe condition. Findings provide a basis for future longitudinal and intervention studies to examine the benefit of SDM for improving parental perceptions of the quality of child mental health care and mental health functioning among children with common mental health conditions.
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Affiliation(s)
- Ashley M Butler
- Department of Pediatrics, Baylor College of Medicine, 1102 Bates St., Suite 940, Houston, TX, 77030, USA.
| | - Bridget Weller
- Department of Psychiatry and Behavioral Sciences, Duke University, Durham, NC, USA
| | - Courtney Titus
- Department of Pediatrics, Baylor College of Medicine, 1102 Bates St., Suite 940, Houston, TX, 77030, USA
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Lindly OJ, Zuckerman KE, Mistry KB. Clarifying the Predictive Value of Family-Centered Care and Shared Decision Making for Pediatric Healthcare Outcomes Using the Medical Expenditure Panel Survey. Health Serv Res 2016; 52:313-345. [PMID: 27072197 DOI: 10.1111/1475-6773.12488] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
OBJECTIVES To estimate (1) family-centered care (FCC) and shared decision-making (SDM) prevalence, and (2) associations of FCC and SDM (FCC/SDM) with health care outcomes among U.S. children. DATA SOURCE The Medical Expenditure Panel Survey Household Component (MEPS-HC), a nationally representative survey of the noninstitutionalized, civilian population. STUDY DESIGN Secondary analyses of prospectively collected data on 15,764 U.S. children were conducted to examine FCC/SDM prevalence in year 1 and associations of FCC/SDM in year 1 with health services utilization, medical expenditures, and unmet health care needs in year 2. DATA COLLECTION/EXTRACTION METHODS We combined four MEPS-HC longitudinal files from 2007 to 2011. PRINCIPAL FINDINGS FCC/SDM prevalence in year 1 varied from 38.6 to 93.7 percent, and it was lower for composites with more stringent scoring approaches. FCC/SDM composites with stringent scoring approaches in year 1 were associated with reduced unmet needs in year 2. FCC/SDM, across all year 1 composites, was not associated with health services utilization or medical expenditures in year 2. FCC/SDM year 1 subcomponents describing consensus building and mutual agreement were consistently associated with unmet health care needs in year 2. CONCLUSIONS FCC/SDM composites with stringent scoring approaches measuring consensus building and mutual agreement may have the greatest utility for pediatric health care quality improvement efforts.
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Affiliation(s)
- Olivia J Lindly
- School of Social and Behavioral Health Sciences, College of Public Health and Human Sciences, Oregon State University, Corvallis, OR.,Division of General Pediatrics, Oregon Health & Science University, Portland, OR
| | | | - Kamila B Mistry
- Agency for Healthcare Research and Quality, Office of Extramural Research, Education, and Priority Populations, Rockville, MD
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Edbrooke-Childs J, Jacob J, Argent R, Patalay P, Deighton J, Wolpert M. The relationship between child- and parent-reported shared decision making and child-, parent-, and clinician-reported treatment outcome in routinely collected child mental health services data. Clin Child Psychol Psychiatry 2016; 21:324-38. [PMID: 26104790 DOI: 10.1177/1359104515591226] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE Shared decision making (SDM) between service users and providers is increasingly being suggested as a key component of good healthcare. The aim of this research was to explore whether child- and parent-reported experience of SDM was associated with child- and parent-reported improvement in psychosocial difficulties and clinician-reported functioning at the end of treatment in child and adolescent mental health services (CAMHS). METHOD The sample comprised N = 177 children (62% female; 31% aged 6-12 and 69% aged 13-18) with a variety of mental health problems from 17 services where routinely collected data consisted of presenting problems at outset, child- and parent-reported change in symptoms between Time 1 and Time 2 (Strengths and Difficulties Questionnaire; SDQ), clinician-reported change in functioning between Time 1 and Time 2 (Children's Global Assessment Scale; CGAS), and experience of SDM at Time 2 (as measured by responses to the Experience of Service Questionnaire; ESQ). RESULTS Analysis revealed that both child- and parent-reported experience of SDM were associated with higher levels of child- and parent-reported improvement in psychosocial difficulties. However, child-reported experience of SDM was only associated with higher levels of child-reported improvement when their parents also reported higher levels of SDM. CONCLUSION In CAMHS, involving both children and parents in decision making may contribute to enhanced treatment outcomes.
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Affiliation(s)
| | - Jenna Jacob
- Child Outcomes Research Consortium, Evidence Based Practice Unit, UCL and Anna Freud Centre, UK
| | - Rachel Argent
- Child Outcomes Research Consortium, Evidence Based Practice Unit, UCL and Anna Freud Centre, UK
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Parent-Reported Shared Decision Making: Autism Spectrum Disorder and Other Neurodevelopmental Disorders. J Dev Behav Pediatr 2016; 37:20-32. [PMID: 26703325 DOI: 10.1097/dbp.0000000000000242] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES Assess differences in parent-reported shared decision making (SDM) based on diagnostic group in a national sample of children with neurodevelopmental disorders (autism spectrum disorder [ASD], cerebral palsy [CP], or Down syndrome [DS]). Assess contribution of medical home and child functional impairment. METHODS Secondary analysis of 2009 to 2010 National Survey of Children with Special Health Care Needs explored reports of 3966 children with ASD, CP, or DS. SDM was defined categorically (SDMcat, present or absent) and continuously (SDMcont, score range 0-12). Regression models were adjusted for child/family characteristics, medical home, functional impairment, and diagnostic group. RESULTS SDMcat and SDMcont were significantly lower in the ASD group (56.7% [95% confidence interval = CI, 53.4-59.9] and mean 8.7 [95% CI, 8.5-9.0]), compared with the CP group (70.5% [95% CI, 63.4-76.7] and mean 9.7 [95% CI, 9.3-10.1]), or the DS group (70.8% [95% CI, 61.2-78.8] and mean 10.0 [95% CI, 9.5-10.4]). In adjusted analyses of SDMcat and SDMcont, SDM was more likely among children with a medical home (adjusted odds ratio 6.6, p < .001, mean = 11.9, and p < .001), and less likely for children with greatest functional impairment (adjusted odds ratio 0.4, p = .002, mean = 10.1, and p = .001). Adjusted analysis of SDMcont also showed differences based on diagnostic group with lower SDMcont scores in the ASD group (mean = 10.1 and p = .005) compared with the DS group. CONCLUSION A medical home was associated with higher SDM, whereas greater functional impairment and ASD diagnosis were associated with lower SDM.
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Schwantes S. The Use of Acupuncture in a Pediatric Chronic Care Setting: Clinical Applications. Med Acupunct 2015. [DOI: 10.1089/acu.2015.1150] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Scott Schwantes
- Gillette Children's Specialty Healthcare, Regions Hospital, University of Minnesota Masonic Children's Hospital, St. Paul, MN
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17
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Butler AM, Elkins S, Kowalkowski M, Raphael JL. Shared decision making among parents of children with mental health conditions compared to children with chronic physical conditions. Matern Child Health J 2015; 19:410-8. [PMID: 24880252 DOI: 10.1007/s10995-014-1523-y] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
High quality care in pediatrics involves shared decision making (SDM) between families and providers. The extent to which children with common mental health disorders experience SDM is not well known. The objectives of this study were to examine how parent-reported SDM varies by child health (physical illness, mental health condition, and comorbid mental and physical conditions) and to examine whether medical home care attenuates any differences. We analyzed data on children (2-17 years) collected through the 2009/2010 National Survey of Children with Special Health Care Needs. The sample consisted of parents of children in one of three child health categories: (1) children with a chronic physical illness but no mental health condition; (2) children with a common mental health condition but no chronic physical condition; and (3) children with comorbid mental and chronic physical conditions. The primary dependent variable was parent-report of provider SDM. The primary independent variable was health condition category. Multivariate linear regression analyses were conducted. Multivariate analyses controlling for sociodemographic variables and parent-reported health condition impact indicated lower SDM among children with a common mental health condition-only (B = -0.40; p < 0.01) and children with comorbid conditions (B = -0.67; p < 0.01) compared to children with a physical condition-only. Differences in SDM for children with a common mental health condition-only were no longer significant in the model adjusting for medical home care. However, differences in SDM for children with comorbid conditions persisted after adjusting for medical home care. Increasing medical home care may help mitigate differences in SDM for children with mental health conditions-only. Other interventions may be needed to improve SDM among children with comorbid mental and physical conditions.
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Affiliation(s)
- Ashley M Butler
- Section of Psychology, Baylor College of Medicine, Houston, TX, USA,
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Lipstein EA, Britto MT. Evolution of Pediatric Chronic Disease Treatment Decisions: A Qualitative, Longitudinal View of Parents' Decision-Making Process. Med Decis Making 2015; 35:703-13. [PMID: 25899248 PMCID: PMC4618270 DOI: 10.1177/0272989x15581805] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2014] [Accepted: 03/11/2015] [Indexed: 01/06/2023]
Abstract
BACKGROUND In the context of pediatric chronic conditions, patients and families are called upon repeatedly to make treatment decisions. However, little is known about how their decision making evolves over time. The objective was to understand parents' processes for treatment decision making in pediatric chronic conditions. METHODS We conducted a qualitative, prospective longitudinal study using recorded clinic visits and individual interviews. After consent was obtained from health care providers, parents, and patients, clinic visits during which treatment decisions were expected to be discussed were video-recorded. Parents then participated in sequential telephone interviews about their decision-making experience. Data were coded by 2 people and analyzed using framework analysis with sequential, time-ordered matrices. RESULTS 21 families, including 29 parents, participated in video-recording and interviews. We found 3 dominant patterns of decision evolution. Each consisted of a series of decision events, including conversations, disease flares, and researching of treatment options. Within all 3 patterns there were both constant and evolving elements of decision making, such as role perceptions and treatment expectations, respectively. After parents made a treatment decision, they immediately turned to the next decision related to the chronic condition, creating an iterative cycle. CONCLUSION In this study, decision making was an iterative process occurring in 3 distinct patterns. Understanding these patterns and the varying elements of parents' decision processes is an essential step toward developing interventions that are appropriate to the setting and that capitalize on the skills families may develop as they gain experience with a chronic condition. Future research should also consider the role of children and adolescents in this decision process.
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Affiliation(s)
- Ellen A. Lipstein
- Center for Innovation in Chronic Disease Care, Division of Adolescent Medicine, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH, USA
- James M. Anderson Center for Health Systems Excellence, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH, USA
- University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Maria T. Britto
- Center for Innovation in Chronic Disease Care, Division of Adolescent Medicine, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH, USA
- James M. Anderson Center for Health Systems Excellence, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH, USA
- University of Cincinnati College of Medicine, Cincinnati, OH, USA
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Schwantes S, O'Brien HW. Pediatric palliative care for children with complex chronic medical conditions. Pediatr Clin North Am 2014; 61:797-821. [PMID: 25084725 DOI: 10.1016/j.pcl.2014.04.011] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
Children with complex chronic medical conditions are at risk for significant distress during multiple points in their life. Pediatric palliative care can meaningfully assist in providing support to the child and family throughout their complex care, managing distressing symptoms, anticipating future decision points, and helping the child and family to thrive in their local community.
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Affiliation(s)
- Scott Schwantes
- Department of Pediatrics, Gillette Children's Specialty Healthcare, Regions Hospital, 200 University Avenue East, St Paul, MN 55101, USA.
| | - Helen Wells O'Brien
- Department of Pediatrics, Gillette Children's Specialty Healthcare, Regions Hospital, 200 University Avenue East, St Paul, MN 55101, USA
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