RT Journal
A1 Brinkman WB, Hartl J, Rawe LM, Sucharew H, Britto MT, Epstein JN
T1 PHysicians&#39; shared decision-making behaviors in attention-deficit/hyperactivity disorder care
JF Archives of Pediatrics & Adolescent Medicine
JO Archives of Pediatrics & Adolescent Medicine
YR 2011
FD November 1
VO 165
IS 11
SP 1013
OP 1019
DO 10.1001/archpediatrics.2011.154
UL http://dx.doi.org/10.1001/archpediatrics.2011.154
AB 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 &lt; .001), private vs public health insurance coverage (adjusted mean difference score, 15.1; 11.2-19.0; P &lt; .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 &lt; .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 &lt; .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.