Using Option Grids: steps toward shared decision-making for neonatal circumcision.
OBJECTIVE
To assess the impact, acceptability and feasibility of a short encounter tool designed to enhance the process of shared decision-making and parental engagement.


METHODS
We analyzed video-recordings of clinical encounters, half undertaken before and half after a brief intervention that trained four clinicians how to use Option Grids, using an observer-based measure of shared decision-making. We also analyzed semi-structured interviews conducted with the clinicians four weeks after their exposure to the intervention.


RESULTS
Observer OPTION(5) scores were higher at post-intervention, with a mean of 33.9 (SD=23.5) compared to a mean of 16.1 (SD=7.1) for pre-intervention, a significant difference of 17.8 (95% CI: 2.4, 33.2). Prior to using the intervention, clinicians used a consent document to frame circumcision as a default practice. Encounters with the Option Grid conferred agency to both parents and clinicians, and facilitated shared decision-making. Clinician reported recognizing the tool's positive effect on their communication process.


CONCLUSIONS
Tools such as Option Grids have the potential to make it easier for clinicians to achieve shared decision-making.


CONCLUSIONS
Encounter tools have the potential to change practice. More research is needed to test their feasibility in routine practice.
Dartmouth Hitchcock Medical Center, Lebanon, USA; Geisel School of Medicine at Dartmouth, Dartmouth College, Hanover, USA. Electronic address: Mary.E.Fay@hitchcock.org.
Mary
M
Fay
The Dartmouth Institute for Health Policy and Clinical Practice, Dartmouth College, Hanover, USA. Electronic address: Stuart.S.W.Grande@dartmouth.edu.
Stuart W
SW
Grande
The Dartmouth Institute for Health Policy and Clinical Practice, Dartmouth College, Hanover, USA. Electronic address: Kyla.Z.Donnelly.GR@dartmouth.edu.
Kyla
K
Donnelly
The Dartmouth Institute for Health Policy and Clinical Practice, Dartmouth College, Hanover, USA. Electronic address: glynelwyn@gmail.com.
Glyn
G
Elwyn
D002944:Circumcision, Male; D003142:Communication; D003657:Decision Making; D003661:Decision Support Techniques; D005240:Feasibility Studies; D006282:Health Personnel / Q000193:education; D006801:Humans; D008297:Male; D010290:Parents; D010353:Patient Education as Topic / Q000379:methods; D010358:Patient Participation; D010817:Physician-Patient Relations; D036301:Qualitative Research
Circumcision; Communication; Encounter tools; Informed consent; Patient decision aids; Patient engagement; Shared decision-making