Decision aid prototype for treatment of pediatric sleep disordered breathing: A randomized pilot study

Abstract

Objectives 1) To examine the feasibility and usability of a decision aid prototype (DA) for pediatric obstructive sleep apnea (OSA). 2) to estimate parameters for a future randomized controlled trial. Study Design Multicenter randomized pilot trial. Methods Ninety‐nine parents of children ( < 6 years of age) undergoing consultation for adenotonsillectomy for sleep‐disordered breathing were prospectively enrolled. Families were randomly assigned to receive the DA or to follow standard care procedures. All consultations were video‐recorded and coded with the observing patient involvement in decision making (OPTION) instrument. Following the consultation, parents completed the Decisional Conflict Scale (DCS) and Shared Decision‐Making Questionnaire (SDM‐Q‐9), whereas otolaryngologists completed the physician version (SDM‐Q‐Doc). A subset of parents and surgeons were interviewed to assess the usability of the DA. Results: Overall, a significantly negative correlation between DCS and SDM‐Q‐9 was observed (P < 0.001). Interviews showed that parents found the DA helpful but wanted more time to read and contemplate the information. Both parents and surgeons indicated that instructions on how to use the DA would be beneficial. For parents receiving the DA, the mean total OPTION score was 13.83 out of 40 (standard deviation 5.24), compared to 11.95 (standard deviation 5.21) in those not receiving the DA (P = 0.11). There were no significant differences in the decisional conflict or shared decision making when using the DA. Conclusion: The DA was feasible but used differently among surgeons. The need to improve SDM techniques was suggested by both surgeons and parents. Future studies training otolaryngologists on effective SDM techniques and how to appropriately utilize decision aids may improve SDM for pediatric OSA. Level of Evidence 1b Laryngoscope, 129:229–234, 2019

Patient Perceived Involvement in Their Treatment is Influenced by Factors Other Than Independently Rated Clinician Communication Effectiveness

“…Discussion. The finding of no (or at most a very small) correlation between patient and clinician ratings of the patient's involvement is consistent with similar studies in pediatrics (r = .16; P = .12) and otolaryngology (r = .24; P < .01 and r = .23; P < .05) (12)(13)(14). One study included cancer survivors with many visits over an extensive period and reported a moderate correlation (r = .41; P < .01) (26).…”

“…Three studies-one each in vascular surgery, anesthesiology, and dermatology-all reported differences between 7% and 39% in mean patient and physician scores but did not report correlations (9)(10)(11). One study in pediatrics and 2 in otolaryngology reported weak to moderate correlations (Spearman rho between 0.16 and 0.41) (12)(13)(14). In all 6 studies, patients rated their involvement higher than physicians.…”

Effect of Respiratory Training Combined with Core Muscle Training on the Overall Motor Function and Activities of Daily Living of Patients with Early and Midterm Stroke

“…However, studies have confirmed [3] that patients have difficulty cooperating with this training due to the influence of disease, and abnormal factors such as abnormal muscle strength and muscular tension will also lead to a poor rehabilitation effect. In addition, a study has confirmed [4] that stroke can lead to respiratory dysfunction in patients, with the clinical manifestations of weak diaphragm contraction, and decreased respiration and inspiratory muscle strength. With the development of cardiopulmonary rehabilitation, respiratory training and core muscle training play an important role in improving the respiratory function of patients with neurological diseases [5].…”

Clinical Decision Support Systems in Otolaryngology–Head and Neck Surgery: A State of the Art Review

“…Several published studies relevant to otolaryngology describe patient‐oriented resources that can help educate and inform consumers about their own care 78–83 . These patient decision aids are tools that help patients navigate choices and make evidence‐based decisions when multiple options exist 84 .…”

“…Several published studies relevant to otolaryngology describe patientoriented resources that can help educate and inform consumers about their own care. [78][79][80][81][82][83] These patient decision aids are tools that help patients navigate choices and make evidence-based decisions when multiple options exist. 84 Notably, all patient decision aids we identified in our review were published within the past 5 years, indicating their marked increase in popularity within the field.…”