Shared decision-making to improve attention-deficit hyperactivity disorder care

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 videorecorded encounters and surveyed parents. Results: Compared to controls, intervention group parents were more involved in shared decisionmaking (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. 41.6 min, 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. Practice implications: Interventions are available to prepare parents for visits and enable physicians to elicit parent preferences and involvement in decision-making. (C) 2013 Elsevier Ireland Ltd. All rights reserved.