Child and Caregiver Involvement and Shared Decision-Making during Asthma Pediatric Visits

Abstract

Objective The purpose of this study was to examine: (a) the extent to which caregivers and children asked asthma management questions during pediatric asthma visits, (b) the extent to which providers engaged in shared decision-making with these caregivers and children, and (c) the factors associated with question-asking and shared decision-making. Methods Children ages 8 through 16 with mild, moderate, or severe persistent asthma and their caregivers were recruited at five pediatric practices in non-urban areas of North Carolina. All of the medical visits were audio-tape recorded. Generalized estimating equations were used to analyze the data. Results Only 13% of children and 33% of caregivers asked one or more questions about asthma management. Caregivers were most likely to ask questions about their child’s medications. Providers obtained child input into their asthma management treatment plan during only 6% of encounters and caregiver input into their child’s asthma management treatment plan during 10% of visits. Conclusion Given the importance of involving patients during health care visits, providers need to consider asking for and including child and caregiver input into asthma management treatment plans so that shared decision-making can occur more frequently.

ADRIC: Adverse Drug Reactions In Children – a programme of research using mixed methods

“…Similar to the findings from studies about other populations, [263][264][265][266][267] the clinicians in this study reported that communication about ADRs was generally important in clinical practice. However, in specific cases they described filtering the information that they discussed with families.…”

Communication During Pediatric Asthma Visits and Self-Reported Asthma Medication Adherence

“…The research assistant explained the study, obtained caregiver consent and child assent, and administered the eligibility screener. 9 Providers and families were told that the study was examining communication during pediatric visits. All of the medical visits were audio-tape recorded.…”

“…Using data from the study' s eligibility screening instrument, asthma severity was classified as mild versus moderate/severe by a research assistant based on the caregiver' s report of the child' s recent symptoms and medication use. [7][8][9] Our eligibility screening instrument used the primary asthma severity classification system that was in use when the study was designed and conducted. [7][8][9] More detail about the asthma severity classification system is provided by Sleath et al 9 A variety of demographic and sociocultural factors were examined as potential confounders.…”

“…[7][8][9] Our eligibility screening instrument used the primary asthma severity classification system that was in use when the study was designed and conducted. [7][8][9] More detail about the asthma severity classification system is provided by Sleath et al 9 A variety of demographic and sociocultural factors were examined as potential confounders. For descriptive purposes, child self-reported race was re-coded into 4 categories: white, African American, Native American/ American Indian, or other.…”

“…7,8 Our previous work demonstrated that providers rarely asked for child or caregiver input into the child' s asthma treatment plan during audio-taped pediatric medical visits. 9 This current article examines how certain aspects of provider-patient communication that are recommended by the national asthma guidelines (ie, number of control medication questions the provider asks, the total number of medication questions asked by children, and the provider asking for child and caregiver input into the asthma treatment plan) are associated with child asthma medication adherence 1 month after the audio-taped visit.…”