5M-1 SHARED DECISION MAKING (SDM) IN PEDIATRIC TYPE 1 DIABETES: EVALUATION OF DECISION COACHING WITH A PATIENT DECISION AID

Wednesday, October 21, 2015: 10:00 AM
Grand Ballroom A (Hyatt Regency St. Louis at the Arch)

Margaret L. Lawson, MD, MSc, FRCP1, Allyson L. Shephard, RN, MScN1, Bryan Feenstra, RN, MScN2, Laura Boland, MSc, PhD(c)3, Nadia Sourial, MSc1 and Dawn Stacey, RN, PhD, CON (C)2, (1)Children's Hospital of Eastern Ontario Research Institute, Ottawa, ON, Canada, (2)University of Ottawa, Ottawa, ON, Canada, (3)University of Ottawa, Institute of Population Health, Ottawa, ON, Canada
Purpose: To evaluate the effect of decision coaching with a decision aid on decisional conflict and participants’ satisfaction for youth and parents considering a change in insulin delivery method (2-3 injections per day vs. multiple daily injections vs. insulin pump therapy).

Methods: Pre-post test design. As part of a hospital-wide SDM implementation project, social workers in a pediatric type 1 diabetes clinic were trained as decision coaches through an online, self-directed tutorial (Ottawa Decision Support Tutorial) and a skill-building workshop that provided foundational SDM knowledge and practise using simulated clinical encounters, audit and feedback. Youth and their parents considering a change in the youth’s insulin delivery method were referred for decision coaching by their diabetes physician. Decision coaches followed a standardized coaching protocol using the dyadic Ottawa Family Decision Guide pre-populated for insulin delivery options. Data were collected from participating family members immediately pre-coaching (T1) and 10-14 days post (T2). Primary outcome was youth and parent decisional conflict measured with the low literary Decisional Conflict Scale (DCS), and compared at T1 and T2 using a paired t-test. Other outcomes included choice predisposition vs actual choice (T1&T2), Preparation for Decision Making Scale (PrepDM) (T2), and satisfaction with coaching questionnaire (T2).

Results: 42 families participated, each consisting of 1 youth and 1-2 parents. Youth (n=42), 52% male, median age 11.5 years (range 6.3-17.7). Parents (n=62), 40% male. Twenty sessions involved youth and both parents (17 youth and female parent; 5 youth and male parent). Coaching sessions averaged 55.2±8.9 minutes. Mean youth DCS decreased from 36.4±19.8(SD) (T1) to 4.6±10.0 (T2) (p<0.0001). Mean parent DCS decreased from 42.0±24.0 (T1) to 3.8±8.0 (T2) (p<0.0001). Between T1 and T2, choice predisposition changed for parents but not youth. 54.6% of youth preferred to share the decision with others; 45.5% preferred to decide themselves after hearing others’ views.  Mean PrepDM scores (T2) were 79.0±14.7 for youth and 77.8.2±17.4 for parents. Ninety-one percent of parents and 58.6% of youth rated the coaching session length as appropriate. Youth (88.9-96.3%) and parents (87.8-100%) rated the coaching session as helpful, clear, balanced, and would definitely/probably recommend it. 

Conclusion: Decision coaching with a decision aid reduced decisional conflict for youth and parents facing a preference-sensitive insulin delivery decision. Youth and parents were satisfied with the decision coaching intervention.

See more of: ORAL ABSTRACTS: SHARED DECISION MAKING AND DECISION SUPPORT INTERVENTIONS

See more of: 37th Annual Meeting of the Society for Medical Decision Making