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