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Shared Decision Making About Starting Anti-TNFs

A Pediatric Perspective

Michel, Hilary K.*; Noll, Robert B.; Siripong, Nalyn; Kim, Sandra C.*; Lipstein, Ellen A.§

Journal of Pediatric Gastroenterology and Nutrition: March 2019 - Volume 68 - Issue 3 - p 339–342
doi: 10.1097/MPG.0000000000002193
Short Communication: Gastroenterology: Inflammatory Bowel Disease

ABSTRACT Shared decision making (SDM) is central to patient-centered medicine and has the potential to improve outcomes for pediatric patients with inflammatory bowel diseases. We surveyed specialists about their use of SDM in the decision to start a tumor necrosis factor-α inhibitor in pediatric patients. Results were compared between those who reported using SDM and those who did not. Of 209 respondents, 157 (75%) reported using SDM. Physician/practice characteristics were similar between users and nonusers. There were no statistically significant differences between groups in the components deemed important to the decision-making process nor the number of barriers or facilitators to SDM. Exploratory analyses suggested that physicians using SDM were more accepting of adolescent involvement in the decision-making process. Our results question the effectiveness of using reported barriers and facilitators to guide interventions to improve use of SDM, and suggest further work is needed to understand the adolescent role in decision making.

*Division of Pediatric Gastroenterology, Hepatology and Nutrition, UPMC Children's Hospital of Pittsburgh, Pittsburgh, PA

Department of Pediatrics, University of Pittsburgh School of Medicine, Pittsburgh, PA

Clinical Translational Science Institute, University of Pittsburgh, Pittsburgh, PA

§James M. Anderson Center for Health Systems Excellence, Cincinnati Children's Hospital Medical Center and University of Cincinnati College of Medicine, Cincinnati, OH.

Address correspondence and reprint requests to Hilary K. Michel, MD, UPMC Children's Hospital of Pittsburgh, 4401 Penn Ave, Pediatric Gastroenterology, 3rd Floor, Pittsburgh, PA 15224 (e-mail:

Received 13 August, 2018

Accepted 4 October, 2018

Supplemental digital content is available for this article. Direct URL citations appear in the printed text, and links to the digital files are provided in the HTML text of this article on the journal's Web site (

Data collection was funded by grant K23HD073149 from the Eunice Kennedy Shriver National Institute of Child Health and Human Development to Dr. Lipstein. Statistical support was funded by NIH Grant UL1-TR-001857.

The authors report no conflicts of interest.

© 2019 by European Society for Pediatric Gastroenterology, Hepatology, and Nutrition and North American Society for Pediatric Gastroenterology,