title: Shared decision-making to improve attention-deficit hyperactivity disorder care.
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.
  
  
  CONCLUSIONS
  Interventions are available to prepare parents for visits and enable physicians to elicit parent preferences and involvement in decision-making.
authors.affiliation: Department of Pediatrics, Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, OH 45229, USA. bill.brinkman@cchmc.org
authors.forename: William B
authors.initials: WB
authors.lastname: Brinkman
authors.forename: Jessica
authors.initials: J
authors.lastname: Hartl Majcher
authors.forename: Lauren M
authors.initials: LM
authors.lastname: Poling
authors.forename: Gaoyan
authors.initials: G
authors.lastname: Shi
authors.forename: Mike
authors.initials: M
authors.lastname: Zender
authors.forename: Heidi
authors.initials: H
authors.lastname: Sucharew
authors.forename: Maria T
authors.initials: MT
authors.lastname: Britto
authors.forename: Jeffery N
authors.initials: JN
authors.lastname: Epstein
mesh_terms: D000328:Adult; D001289:Attention Deficit Disorder with Hyperactivity / Q000175:diagnosis* / Q000628:therapy; D002648:Child; D003657:Decision Making; D003661:Decision Support Techniques; D006801:Humans; D008297:Male; D008875:Middle Aged; D009820:Ohio; D010290:Parents / Q000193:education* / Q000523:psychology; D010347:Patient Care Planning; D010353:Patient Education as Topic / Q000379:methods; D010820:Physicians; D010818:Practice Patterns, Physicians'; D011320:Primary Health Care; D017064:Process Assessment, Health Care; D011368:Professional-Family Relations
keywords: ADHD; Adherence; Attention-deficit hyperactivity disorder; Decision aids; Family/self-management; SDM; Shared decision-making; attention-deficit hyperactivity disorder; shared decision-making