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J Pediatr Gastroenterol Nutr. 2018 Nov 8. doi: 10.1097/MPG.0000000000002193. [Epub ahead of print]

Shared Decision Making About Starting anti-TNFs: A Pediatric Perspective.

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Gastroenterology, Hepatology and Nutrition, UPMC Children's Hospital of Pittsburgh, Pittsburgh, PA, United States.
Department of Pediatrics, University of Pittsburgh, Pittsburgh, PA, United States.
Clinical Translational Science Institute, University of Pittsburgh, Pittsburgh, PA, United States.
Adolescent and Transition Medicine, Cincinnati Children's Hospital Medical Center and University of Cincinnati College of Medicine, Cincinnati, OH, United States.


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 non-users. 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.

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