Liverpool Shaun, Hayes Daniel, Edbrooke-Childs Julian
Evidence Based Practice Unit, University College London and Anna Freud National Centre for Children and Families, London, United Kingdom.
Faculty of Health, Social Care and Medicine, Edge Hill University, Ormskirk, United Kingdom.
Front Psychiatry. 2021 Jul 15;12:676721. doi: 10.3389/fpsyt.2021.676721. eCollection 2021.
Shared decision making (SDM) has been associated with positive outcomes at child and adolescent mental health services (CAMHS). However, implementing SDM is sometimes challenging. Understanding the factors associated with parent/carer experience of SDM could provide empirical evidence to support targeted efforts to promote SDM. This study aimed to explore the frequency of parent/carer-reported experience of SDM and examine possible associations between SDM and clinician's perceptions of the (a) children's and young people's psychosocial difficulties, (b) additional complex problems, and (c) impact of the psychosocial difficulties. Secondary analysis was conducted on administrative data collected from CAMHS between 2011 and 2015. The sample was composed of 3,175 cases across 58 sites in England. Frequencies were recorded and associations were explored between clinician-reported measures and parent/carer-reported experiences of SDM using a two-level mixed-effect logistic regression analytic approach. Almost 70% of parents/carers reported experiencing higher levels of SDM. Individual-level variables in model one revealed statistically significant ( <0.05) associations suggesting Asian parents/carers (OR = 1.95, 95% CI [1.4, 2.73]) and parents/carers having children with learning difficulties (OR = 1.45, 95% CI [1.06, 1.97]) were more likely to report higher levels of SDM. However, having two parents/carers involved in the child's care and treatment decisions (OR = 0.3, 95% CI [0.21, 0.44]) and being a parent/carer of a child or young person experiencing conduct problems (OR = 0.78, 95% CI [0.63, 0.98]) were associated with lower levels of SDM. When adjusting for service level data (model two) the presence of conduct problems was the only variable found to be significant and predicted lower levels of SDM (OR = 0.29, 95% CI [0.52, 0.58]). Multilevel modelling of CAMHS administrative data may help identify potential influencing factors to SDM. The current findings may inform useful models to better predict and support SDM.
共同决策（SDM）与儿童和青少年心理健康服务（CAMHS）的积极结果相关。然而，实施SDM有时具有挑战性。了解与父母/照顾者的SDM体验相关的因素可为促进SDM的针对性努力提供实证依据。本研究旨在探讨父母/照顾者报告的SDM体验的频率，并检验SDM与临床医生对（a）儿童和青少年的心理社会困难、（b）其他复杂问题以及（c）心理社会困难的影响的看法之间可能存在的关联。对2011年至2015年期间从CAMHS收集的行政数据进行了二次分析。样本包括英格兰58个地点的3175个案例。记录了频率，并使用二级混合效应逻辑回归分析方法探讨了临床医生报告指标与父母/照顾者报告的SDM体验之间的关联。近70%的父母/照顾者报告称经历了较高水平的SDM。模型一中的个体层面变量显示出具有统计学意义（<0.05）的关联，表明亚洲父母/照顾者（OR = 1.95，95%CI [1.4, 2.73]）以及孩子有学习困难的父母/照顾者（OR = 1.45，95%CI [1.06, 1.97]）更有可能报告较高水平的SDM。然而，有两位父母/照顾者参与孩子的护理和治疗决策（OR = 0.3，95%CI [0.21, 0.44]）以及作为有行为问题的儿童或青少年的父母/照顾者（OR = 0.78，95%CI [0.63, 0.98]）与较低水平的SDM相关。在对服务层面数据进行调整（模型二）时，发现存在行为问题是唯一具有显著意义的变量，并预测SDM水平较低（OR = 0.29，95%CI [启0.52, 0.58]）。对CAMHS行政数据进行多层次建模可能有助于识别影响SDM的潜在因素。当前的研究结果可能为更好地预测和支持SDM的有用模型提供信息。
