Patient Related Outcome Measures (May 2018)
Provider use of a participatory decision-making style with youth and caregivers and satisfaction with pediatric asthma visits
Abstract
Betsy Sleath,1,2 Delesha M Carpenter,1 Imelda Coyne,3 Scott A Davis,1 Claire Hayes Watson,1 Ceila E Loughlin,4 Nacire Garcia,1 Daniel S Reuland,5 Gail E Tudor6 1Division of Pharmaceutical Outcomes and Policy, UNC Eshelman School of Pharmacy, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA; 2Cecil G. Sheps Center for Health Services Research, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA; 3School of Nursing and Midwifery, Trinity College, Dublin, Ireland; 4Department of Pediatric Pulmonology, School of Medicine University of North Carolina at Chapel Hill, Chapel Hill, NC, USA; 5Division of General Internal Medicine and Clinical Epidemiology, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA; 6Department of Science and Mathematics, Husson University, Bangor, ME, USA Background: We conducted a randomized controlled trial to test the effectiveness of an asthma question prompt list with video intervention to engage the youth during clinic visits. We examined whether the intervention was associated with 1) providers including youth and caregiver inputs more into asthma treatment regimens, 2) youth and caregivers rating providers as using more of a participatory decision-making style, and 3) youth and caregivers being more satisfied with visits.Methods: English- or Spanish-speaking youth aged 11–17 years with persistent asthma and their caregivers were recruited from four pediatric clinics and randomized to the intervention or usual care groups. The youth in the intervention group watched the video with their caregivers on an iPad and completed a one-page asthma question prompt list before their clinic visits. All visits were audiotaped. Generalized estimating equations were used to analyze the data.Results: Forty providers and their patients (n=359) participated in this study. Providers included youth input into the asthma management treatment regimens during 2.5% of visits and caregiver input during 3.3% of visits. The youth in the intervention group were significantly more likely to rate their providers as using more of a participatory decision-making style (odds ratio=1.7, 95% confidence interval=1.1, 2.5). White caregivers were significantly more likely to rate the providers as more participatory (odds ratio=2.3, 95% confidence interval=1.2, 4.4). Youth (beta=4.9, 95% confidence interval=3.3, 6.5) and caregivers (beta=7.5, 95% confidence interval=3.1, 12.0) who rated their providers as being more participatory were significantly more satisfied with their visits. Youth (beta=–1.9, 95% confidence interval=–3.4, –0.4) and caregivers (beta=–8.8, 95% confidence interval=–16.2, –1.3) who spoke Spanish at home were less satisfied with visits. Conclusion: The intervention did not increase the inclusion of youth and caregiver inputs into asthma treatment regimens. However, it did increase the youth’s perception of participatory decision-making style of the providers, and this in turn was associated with greater satisfaction. Keywords: shared decision-making, patient–provider, question prompt list, video intervention, communication, intervention
