An assessment of the shared-decision model in parents of children with acute otitis media.
OBJECTIVE
Medicine is shifting from a doctor-centered approach to a model entailing more shared decision-making. Many organizations now recommend a shared-decision approach to treating children with acute otitis media (AOM). Our primary objectives in this study were to assess (1) which style of decision-making on the physician's part would most effectively reduce parents' proclivity to use antibiotics for treatment of their child's AOM and (2) parental satisfaction with different doctor-patient decision-making styles.


METHODS
We conducted a cross-sectional survey to examine how parents respond to doctor-patient communication styles in 3 clinical vignettes that presented 2 versions of a shared-decision model (SDM) and 1 paternalistic model. Parents were randomly assigned to receive 1 of 3 vignettes. The main predictor variable was the vignette assignment, and the main outcomes were (1) parent proclivity to use antibiotics and (2) parent ratings of care by the physician in the vignette. Using logistic regression, we adjusted for caregivers' age, gender, income, knowledge of antibiotics, decision-making preference, confidence in physician, and length of relationship with personal physician.


RESULTS
Four hundred sixty-six parents met inclusion criteria, with a response rate of 94%. General characteristics were similar across vignette assignment groups. Parents who received the paternalistic-model vignettes were more likely to say that they would use antibiotics than those who received the SDM vignettes (odds ratio: 4.9; 95% confidence interval: 2.3-10.6). This result remained statistically significant after adjustment for potential confounders. In addition, parents in the shared-decision groups were more satisfied (93% and 84%) than those in the paternalistic-model group (76%).


CONCLUSIONS
To our knowledge, this is the first study to examine parent interest, acceptance, and satisfaction with the SDM. Our findings suggest that shared decision-making for AOM may lead to less antibiotic usage and higher levels of parental satisfaction. Although more studies are needed to examine how best to incorporate parents in the SDM, our study serves as an example of the potential benefit of this approach in pediatric medicine.
Merenstein
Dan
D
Robert Wood Johnson Clinical Scholars Program, Johns Hopkins School of Medicine, Baltimore, Maryland, USA. djm23@georgetown.edu
Diener-West
Marie
M
Krist
Alex
A
Pinneger
Matthew
M
Cooper
Lisa A
LA
D000328:Adult; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D002648:Child; D002675:Child, Preschool; D003430:Cross-Sectional Studies; D003661:Decision Support Techniques; D005260:Female; D006801:Humans; D007223:Infant; D008297:Male; D008875:Middle Aged; D010033:Otitis Media / Q000188:drug therapy*; D010290:Parents / Q000523:psychology*; D010358:Patient Participation; D017060:Patient Satisfaction; D010817:Physician-Patient Relations; D012959:Socioeconomic Factors
D000900:Anti-Bacterial Agents