Abstract
BackgroundChoice of insulin delivery for type 1 diabetes can be difficult for many parents and children. We evaluated decision coaching using a patient decision aid for helping youth with type 1 diabetes and parents decide about insulin delivery method.MethodsA pre/post design. Youth and parent(s) attending a pediatric diabetes clinic in a tertiary care centre were referred to the intervention by their pediatric endocrinologist or diabetes physician between September 2013 and May 2015. A decision coach guided youth and their parents in completing a patient decision aid that was pre-populated with evidence on insulin delivery options. Primary outcomes were youth and parent scores on the low literary version of the validated Decisional Conflict Scale (DCS).ResultsForty-five youth (mean age = 12.5 ± 2.9 years) and 66 parents (45.8 ± 5.6 years) participated. From pre- to post-intervention, youth and parent decisional conflict decreased significantly (youth mean DCS score was 32.0 vs 6.6, p < 0.0001; parent 37.6 vs 3.5, p < 0.0001). Youth’s and parents’ mean decisional conflict scores were also significantly improved for DCS subscales (informed, values clarity, support, and certainty). 92% of youth and 94% of parents were satisfied with the decision coaching and patient decision aid. Coaching sessions averaged 55 min. Parents (90%) reported that the session was the right length of time; some youth (16%) reported that it was too long.ConclusionDecision coaching with a patient decision aid reduced decisional conflict for youth and parents facing a decision about insulin delivery method.
Highlights
Choice of insulin delivery for type 1 diabetes can be difficult for many parents and children
In 2012, we conducted a pilot study to evaluate the feasibility of delivering a decision support intervention consisting of decision coaching using a patient decision aid with youth (n = 7) ages 9 to 17 years who were considering a change in insulin delivery method and their parents or legal guardians
Our decision support intervention using decision coaching with a patient decision aid promoted shared decision making between youth and parents who were considering whether to change the youths’ insulin delivery method
Summary
Choice of insulin delivery for type 1 diabetes can be difficult for many parents and children. We evaluated decision coaching using a patient decision aid for helping youth with type 1 diabetes and parents decide about insulin delivery method. The choice of insulin delivery method is preference sensitive, regardless of the youths’ age, requiring the potential benefits and harms of each option to be weighed by the patient and their family when deciding a treatment plan. In 2012, we conducted a pilot study to evaluate the feasibility of delivering a decision support intervention consisting of decision coaching using a patient decision aid with youth (n = 7) ages 9 to 17 years who were considering a change in insulin delivery method and their parents or legal guardians (collectively referred to as ‘parents’). The objective of this study was to evaluate decision coaching using a patient decision aid on youth and parents’ decisional conflict (primary outcome). We hypothesized that parent and youth decisional conflict would decrease after exposure to the shared decision making intervention
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