Division of Developmental and Behavioral Pediatrics, Department of Pediatrics, Golisano Children's Hospital, University of Rochester, Rochester, NY.
Division of Developmental and Behavioral Pediatrics, Department of Pediatrics, Tufts Children's Hospital, Tufts University School of Medicine, Boston, MA.
J Dev Behav Pediatr. 2022;43(2):71-79. doi: 10.1097/DBP.0000000000001002.
Providers of children with autism spectrum disorder (hereafter "autism") report higher levels of shared decision-making during initial diagnostic and treatment planning visits than observed. The goal of this study was to qualitatively explore this discrepancy by investigating provider perceptions of the parent-provider decision-making process in early treatment planning and the role for parents in this process.
We conducted semistructured qualitative interviews with developmental behavioral pediatricians (DBPs; n = 15) to investigate how they approach early treatment planning with parents. We analyzed participant characteristics using descriptive statistics. Interviews were audio-recorded, transcribed, and independently coded by 2 researchers until consensus was reached. Analyses were conducted using a modified grounded theory framework.
DBPs reported that their primary role during early treatment planning was to provide diagnostic clarification and that parents' primary role was to learn as much as they can about autism. Most DBPs wanted treatment planning to be collaborative, and perceived that parents had the same preference but might not have the knowledge or skills to effectively participate. DBPs identified additional barriers that influence the extent to which they engage parents in the collaborative decision-making and provided recommendations for enhancing the process.
DBPs are proponents of collaborative treatment planning between parents and providers; however, there are many obstacles that prevent this. Strategies such as decision tools or aids and larger systemic reforms are necessary to support DBPs and parents in this process.
患有自闭症谱系障碍（以下简称“自闭症”）的儿童的提供者报告说，在初始诊断和治疗计划访视期间，共享决策的水平高于观察到的水平。本研究的目的是通过调查提供者对早期治疗计划中父母-提供者决策过程的看法以及父母在这一过程中的作用，来定性地探讨这一差异。
我们对发育行为儿科医生（DBPs；n=15）进行了半结构化定性访谈，以调查他们如何与父母一起进行早期治疗计划。我们使用描述性统计数据对参与者特征进行了分析。访谈进行了录音、转录，并由两名研究人员独立编码，直到达成共识。分析采用了修正的扎根理论框架。
DBPs 报告说，他们在早期治疗计划中的主要角色是提供诊断澄清，而父母的主要角色是尽可能多地了解自闭症。大多数 DBPs 希望治疗计划是协作的，并认为父母有同样的偏好，但可能没有知识或技能来有效地参与。DBPs 确定了影响他们与父母进行协作决策程度的其他障碍，并提出了加强这一过程的建议。
DBPs 支持父母和提供者之间的协作治疗计划；然而，有许多障碍阻止了这一点。决策工具或辅助工具以及更大的系统改革等策略对于支持 DBPs 和父母在这一过程中是必要的。
