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Hood AM, Strong H, Nwankwo C, Johnson Y, Peugh J, Mara CA, Shook LM, Brinkman WB, Real FJ, Klein MD, Hackworth R, Badawy SM, Thompson AA, Raphael JL, Yates AM, Smith-Whitley K, King AA, Calhoun C, Creary SE, Piccone CM, Hildenbrand AK, Reader SK, Neumayr L, Meier ER, Sobota AE, Rana S, Britto M, Saving KL, Treadwell M, Quinn CT, Ware RE, Crosby LE. Engaging Caregivers and Providers of Children With Sickle Cell Anemia in Shared Decision Making for Hydroxyurea: Protocol for a Multicenter Randomized Controlled Trial. JMIR Res Protoc 2021; 10:e27650. [PMID: 34018965 PMCID: PMC8178738 DOI: 10.2196/27650] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2021] [Revised: 02/17/2021] [Accepted: 02/22/2021] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND Sickle cell anemia (SCA) is a genetic blood disorder that puts children at a risk of serious medical complications, early morbidity and mortality, and high health care utilization. Until recently, hydroxyurea was the only disease-modifying treatment for this life-threatening disease and has remained the only option for children younger than 5 years. Evidence-based guidelines recommend using a shared decision-making (SDM) approach for offering hydroxyurea to children with SCA (HbSS or HbS/β0 thalassemia) aged as early as 9 months. However, the uptake remains suboptimal, likely because caregivers lack information about hydroxyurea and have concerns about its safety and potential long-term side effects. Moreover, clinicians do not routinely receive training or tools, especially those that provide medical evidence and consider caregivers' preferences and values, to facilitate a shared discussion with caregivers. OBJECTIVE The aim of this study is to understand how best to help parents of young children with sickle cell disease and their clinicians have a shared discussion about hydroxyurea (one that considers medical evidence and parent values and preferences). METHODS We designed our study to compare the effectiveness of two methods for disseminating hydroxyurea guidelines to facilitate SDM: a clinician pocket guide (ie, usual care) and a clinician hydroxyurea SDM toolkit (H-SDM toolkit). Our primary outcomes are caregiver reports of decisional uncertainty and knowledge of hydroxyurea. The study also assesses the number of children (aged 0-5 years) who were offered and prescribed hydroxyurea and the resultant health outcomes. RESULTS The Ethics Committee of the Cincinnati Children's Hospital Medical Center approved this study in November 2017. As of February 2021, we have enrolled 120 caregiver participants. CONCLUSIONS The long-term objective of this study is to improve the quality of care for children with SCA. Using multicomponent dissemination methods developed in partnership with key stakeholders and designed to address barriers to high-quality care, caregivers of patients with SCA can make informed and shared decisions about their health. TRIAL REGISTRATION ClinicalTrials.gov NCT03442114; https://clinicaltrials.gov/ct2/show/NCT03442114. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) DERR1-10.2196/27650.
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Affiliation(s)
- Anna M Hood
- Developmental Neurosciences, Institute of Child Health, University College London, London, United Kingdom
| | - Heather Strong
- Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, United States
| | - Cara Nwankwo
- Department of Psychology, Oklahoma State University, Stillwater, OK, United States
| | - Yolanda Johnson
- Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, United States
| | - James Peugh
- Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, United States
| | - Constance A Mara
- Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, United States
| | - Lisa M Shook
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, United States
- Division of Hematology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, United States
| | - William B Brinkman
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, United States
- Division of General and Community Pediatrics, Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, OH, United States
| | - Francis J Real
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, United States
- Division of General and Community Pediatrics, Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, OH, United States
| | - Melissa D Klein
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, United States
- Division of General and Community Pediatrics, Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, OH, United States
| | - Rogelle Hackworth
- Cincinnati Children's Hospital Medical Center Partner, Cincinnati, OH, United States
| | - Sherif M Badawy
- Department of Pediatrics, Feinberg School of Medicine, Northwestern University, Chicago, IL, United States
- Division of Hematology, Oncology and Stem Cell Transplant, Ann & Robert Lurie Children's Hospital of Chicago, Chicago, IL, United States
| | - Alexis A Thompson
- Department of Pediatrics, Feinberg School of Medicine, Northwestern University, Chicago, IL, United States
- Division of Hematology, Oncology and Stem Cell Transplant, Ann & Robert Lurie Children's Hospital of Chicago, Chicago, IL, United States
| | - Jean L Raphael
- Center for Child Health Policy and Advocacy, Baylor College of Medicine, Houston, TX, United States
| | - Amber M Yates
- Department of Pediatrics, Division of Hematology/Oncology, Baylor College of Medicine, Houston, TX, United States
| | - Kim Smith-Whitley
- Children's Hospital of Philadelphia, Philadelphia, PA, United States
- Perelman School of Medicine, Philadelphia, PA, United States
| | - Allison A King
- Program in Occupational Therapy and Pediatrics, Division of Hematology and Oncology, Washington University School of Medicine and St. Louis Children's Hospital, St. Louis, MO, United States
- Division of Pediatric Hematology/Oncology, Washington University School of Medicine, St. Louis, MO, United States
| | - Cecelia Calhoun
- Division of Pediatric Hematology/Oncology, Washington University School of Medicine, St. Louis, MO, United States
| | - Susan E Creary
- Center for Innovation in Pediatric Practice, Division of Pediatric Hematology/Oncology/BMT, Nationwide Children's Hospital, Columbus, OH, United States
| | - Connie M Piccone
- University Hospitals Rainbow Babies and Children's Hospital, Cleveland, OH, United States
| | - Aimee K Hildenbrand
- Center for Healthcare Delivery Science, Nemours Children's Health System, Wilmington, DE, United States
- Division of Behavioral Health, Nemours/ Alfred I duPont Hospital for Children, Wilmington, DE, United States
| | - Steven K Reader
- Center for Healthcare Delivery Science, Nemours Children's Health System, Wilmington, DE, United States
- Division of Behavioral Health, Nemours/ Alfred I duPont Hospital for Children, Wilmington, DE, United States
| | - Lynne Neumayr
- Department of Hematology/Oncology, Children's Hospital Oakland, Oakland, CA, United States
- AbbVie, North Chicago, IL, United States
- University of California San Francisco, San Francisco, CA, United States
| | - Emily R Meier
- Pediatrics, Pediatric Hematology/Oncology, Indiana Hemophilia and Thrombosis Center, Indianapolis, IN, United States
| | - Amy E Sobota
- Pediatric Hematology and Oncology, Boston Medical Center, Boston, MA, United States
| | - Sohail Rana
- Pediatrics and Child Health, College of Medicine, Howard University, Washington, DC, United States
| | - Maria Britto
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, United States
- Adolescent and Transition Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, United States
- James M. Anderson Center for Health Systems Excellence, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, United States
| | - Kay L Saving
- Department of Pediatrics, University of Illinois College of Medicine, Peoria, IL, United States
| | - Marsha Treadwell
- Department of Hematology/Oncology, University of California San Francisco Benioff Children's Hospital, Oakland, CA, United States
| | - Charles T Quinn
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, United States
- Cancer and Blood Diseases Institute, Division of Hematology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, United States
| | - Russell E Ware
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, United States
- Division of Hematology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, United States
| | - Lori E Crosby
- Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, United States
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, United States
- James M. Anderson Center for Health Systems Excellence, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, United States
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