Shared Decision-Making in Growth Hormone Therapy—Implications for Patient Care

Abstract

Several studies have shown that adherence to growth hormone therapy (GHT) is not optimal. There are several reasons why patients may not fully adhere to their treatment regimen and this may have implications on treatment success, patient outcomes and healthcare spending and resourcing. A change in healthcare practices, from a physician paternalistic to a more patient autonomous approach to healthcare, has encouraged a greater onus on a shared decision-making (SDM) process whereby patients are actively encouraged to participate in their own healthcare decisions. There is growing evidence to suggest that SDM may facilitate patient adherence to GHT. Improved adherence to therapy in this way may consequently positively impact treatment outcomes for patients. Whilst SDM is widely regarded as a healthcare imperative, there is little guidance on how it should be best implemented. Despite this, there are many opportunities for the implementation of SDM during the treatment journey of a patient with a GH-related disorder. Barriers to the successful practice of SDM within the clinic may include poor patient education surrounding their condition and treatment options, limited healthcare professional time, lack of support from clinics to use SDM, and healthcare resourcing restrictions. Here we discuss the opportunities for the implementation of SDM and the barriers that challenge its effective use within the clinic. We also review some of the potential solutions to overcome these challenges that may prove key to effective patient participation in treatment decisions. Encouraging a sense of empowerment for patients will ultimately enhance treatment adherence and improve clinical outcomes in GHT.

Impact of adherence on growth response during the first 2 years of growth hormone treatment

“…Nonadherence to rhGH treatment impacts growth response [27]. Consistently, and in concordance with the results of the ECOS study [8,24], patients with a higher adherence rate during 2 years showed higher HV (cm/year and SDS), and therefore greater height gain (SDS).…”

“…Our results also showed that the education level of the parents was associated with a greater adherence during the first and second year of rhGH treatment. Though this correlation has been previously reported (either with regards to the level of education of the mother, father or both) [30,31], the evidence has not been consistent [27].…”

“…In addition to the duration of treatment, other factors showed a negative correlation with the adherence, such as pretreatment HV. This could be justified by the fact that low HV could raise awareness of the need for treatment and its benefits, and thereby influence adherence [27]. Patients that fit this category show the greatest improvement in HV during the first year, which confirms the impact of adherence on response to rhGH treatment [8].…”

Positive Impact of Targeted Educational Intervention in Children With Low Adherence to Growth Hormone Treatment Identified by Use of the Easypod™ Electronic Auto-injector Device

“…The ability to exclude non-adherence to treatment in non-responders by electronic monitoring therefore represents an important advantage in patient care. The recommended measures to promote adherence to treatment are directly related to the factors that contribute to poor adherence (3,9). But first, it is essential to have methods capable of objectively evaluating the degree of therapeutic adherence of patients with r-hGH deficiency.…”

Personalized approach to growth hormone replacement in adults

“…For all long-term treatments, adherence is one of the factors that determines treatment success together with patient characteristics, therapy area challenges, treatment access, and healthcare provision (36). Individual responsiveness is therefore very likely influenced by adherence.…”