Lipstein Ellen A, Lindly Olivia J, Anixt Julia S, Britto Maria T, Zuckerman Katharine E
Division of Adolescent Medicine, Center for Innovation in Chronic Disease Care, Cincinnati Children's Hospital Medical Center, 3333 Burnet Ave, MLC 7027, Cincinnati, OH, 45229, USA.
James M. Anderson Center for Health Systems Excellence, Cincinnati Children's Hospital Medical Center, 3333 Burnet Ave, Cincinnati, OH, USA.
Matern Child Health J. 2016 Mar;20(3):665-73. doi: 10.1007/s10995-015-1866-z.
Shared decision making (SDM) is most needed when there are multiple treatment options and no "right" choice. As with quality and experience of care, frequency of SDM may vary by health condition. The objectives of this study were (1) to compare parent report of SDM between a physical and a behavioral health condition and; (2) to compare parent report of SDM between two different behavioral health conditions.
Data on children age 3-17 years with asthma, attention deficit/hyperactivity disorder (ADHD), and/or autism spectrum disorder (ASD) were drawn from the 2009/10 National Survey of Children with Special Health Care Needs. Weighted logistic regression was used to compare a parent-reported, composite measure of SDM. Analyses controlled for sociodemographic factors that may influence experience of SDM.
Compared to parents of children with asthma, parents of children with ADHD were significantly less likely to report experiencing consistent SDM (AOR 0.73). Compared to parents of children with ADHD, those of children with ASD had significantly lower odds of experiencing consistent SDM (AOR 0.59). Those with both ADHD and ASD had the same odds as those with ASD alone of experiencing consistent SDM.
Use of SDM is particularly limited in developmental and behavioral conditions, such as ADHD and ASD. These data suggest that challenges to implementing SDM may include disease type, complexity, and use of specialty care. Research to identify specific barriers and facilitators of SDM is needed to inform interventions that will promote SDM in developmental and behavioral conditions.
当存在多种治疗选择且没有“正确”选择时，共享决策（SDM）最为必要。与医疗质量和体验一样，SDM的频率可能因健康状况而异。本研究的目的是：（1）比较身体疾病和行为健康状况下家长对SDM的报告；（2）比较两种不同行为健康状况下家长对SDM的报告。
关于3 - 17岁患有哮喘、注意力缺陷多动障碍（ADHD）和/或自闭症谱系障碍（ASD）儿童的数据来自2009/10年全国特殊医疗需求儿童调查。采用加权逻辑回归比较家长报告的SDM综合指标。分析控制了可能影响SDM体验的社会人口学因素。
与哮喘患儿的家长相比，ADHD患儿的家长报告经历持续SDM的可能性显著降低（调整后比值比[AOR]为0.73）。与ADHD患儿的家长相比，ASD患儿的家长经历持续SDM的几率显著更低（AOR为0.59）。同时患有ADHD和ASD的患儿与仅患有ASD的患儿经历持续SDM的几率相同。
在发育和行为状况（如ADHD和ASD）中，SDM的使用尤其有限。这些数据表明，实施SDM的挑战可能包括疾病类型、复杂性以及专科护理的使用。需要开展研究以确定SDM的具体障碍和促进因素，为在发育和行为状况中促进SDM的干预措施提供依据。
