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Shared clinicianpatient decision-making about treatment of pediatric asthma: what do we know and how can we use it?

Rivera-Spoljaric, Katherine; Halley, Meghan; Wilson, Sandra R.

Current Opinion in Allergy & Clinical Immunology:
doi: 10.1097/ACI.0000000000000046
PEDIATRIC ASTHMA AND DEVELOPMENT OF ATOPY: Edited by Carlos E. Baena-Cagnani and Leonard B. Bacharier
Abstract

Purpose of review: Shared decision-making (SDM) is an emerging field that promises to improve healthcare. We aim to explore the concept of SDM, how it has been studied or applied in the treatment of asthma, and how it might be implemented to improve adherence and outcomes in pediatric asthma.

Recent findings: Healthcare providers often fail to involve their patients in clinical decision-making by not presenting all available options, associated risks and benefits, in light of the patient's values, preferences, concerns, lifestyle, and perceived barriers to following various treatment regimens. It has been argued that SDM is preferable to a clinician-controlled approach and may improve patient outcomes (increase satisfaction with care, reduce decisional conflict and decisional regret, improve health-related quality of life, and increase decision-specific knowledge). This may be especially important in managing chronic conditions in which adherence to treatment regimen may increase if the patient was actively involved in the decision-making. In pediatrics, the decision process is further complicated by the clinician–parent(s)–child interaction. We found no studies on how to effectively involve and communicate with children at different developmental levels, or how to coalesce the parent and child's perspective to work as a unit.

Summary: SDM has the promise to improve satisfaction with disease management, treatment adherence and patient-centered outcomes in pediatric asthma, but further research is needed to determine its effectiveness and to establish guidelines on how to implement SDM in the clinical setting and incorporate the input and preferences of all stakeholders’ perspectives.

Author Information

aWashington University School of Medicine, St. Louis, Missouri

bPalo Alto Medical Research Foundation, Palo Alto, California, USA

Correspondence to Katherine Rivera-Spoljaric, MD, MSCI, Washington University School of Medicine, Department of Pediatrics, Campus Box 8116-NWT, St. Louis, MO 63110-1077, USA. Tel: +1 314 454 2694; fax: +1 314 454 2515; e-mail: rivera_k@kids.wustl.edu

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