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Health Expect. 2019 Nov 23. doi: 10.1111/hex.12965. [Epub ahead of print]

What is the effect of a decision aid in potentially vulnerable parents? Insights from the head CT choice randomized trial.

Author information

1
Department of Emergency Medicine, University of Alabama at Birmingham, Birmingham, AL, USA.
2
Departments of Emergency Medicine and Pediatrics, University of California Davis School of Medicine, University of California Davis Health, Sacramento, CA, USA.
3
Division of Pediatric Emergency Medicine, Departments of Emergency Medicine and Pediatrics, Mayo Clinic, Rochester, MN, USA.
4
Department of Pediatric Emergency Medicine, Children's Hospitals and Clinics of Minnesota, Minneapolis, MN, USA.
5
Department of Emergency Medicine, University of California Davis School of Medicine, University of California Davis Health, Sacramento, CA, USA.
6
Division of Pediatric Emergency Medicine, Department of Pediatrics, University of Minnesota, Minneapolis, MN, USA.
7
Division of Emergency Medicine, Nationwide Children's Hospital, Columbus, OH, USA.
8
Division of Emergency Medicine, Boston Children's Hospital, Boston, MA, USA.
9
Parent Representative, Rochester, MN, USA.
10
Division of Health Care Policy and Research, Department of Health Sciences Research, Mayo Clinic College of Medicine, Rochester, MN, USA.
11
Mayo Clinic Robert D. and Patricia E. Kern Center for the Science of Healthcare Delivery, Rochester, MN, USA.
12
Division of Trauma, Critical Care and General Surgery, Departments of Emergency Medicine and Surgery, Mayo Clinic College of Medicine, Rochester, MN, USA.
13
Yale University School of Medicine, New Haven, CT, USA.
14
Health Research & Educational Trust, Chicago, IL, USA.
15
Knowledge and Evaluation Research Unit, Department of Internal Medicine, Mayo Clinic, Rochester, MN, USA.
16
Department of Emergency Medicine, Mayo Clinic, Rochester, MN, USA.

Abstract

OBJECTIVE:

To test the hypotheses that use of the Head CT Choice decision aid would be similarly effective in all parent/patient dyads but parents with high (vs low) numeracy experience a greater increase in knowledge while those with low (vs high) health literacy experience a greater increase in trust.

METHODS:

This was a secondary analysis of a cluster randomized trial conducted at seven sites. One hundred seventy-two clinicians caring for 971 children at intermediate risk for clinically important traumatic brain injuries were randomized to shared decision making facilitated by the DA (n = 493) or to usual care (n = 478). We assessed for subgroup effects based on patient and parent characteristics, including socioeconomic status (health literacy, numeracy and income). We tested for interactions using regression models with indicators for arm assignment and study site.

RESULTS:

The decision aid did not increase knowledge more in parents with high numeracy (P for interaction [Pint ] = 0.14) or physician trust more in parents with low health literacy (Pint  = 0.34). The decision aid decreased decisional conflict more in non-white parents (decisional conflict scale, -8.14, 95% CI: -12.33 to -3.95; Pint  = 0.05) and increased physician trust more in socioeconomically disadvantaged parents (trust in physician scale, OR: 8.59, 95% CI: 2.35-14.83; Pint  = 0.04).

CONCLUSIONS:

Use of the Head CT Choice decision aid resulted in less decisional conflict in non-white parents and greater physician trust in socioeconomically disadvantaged parents. Decision aids may be particularly effective in potentially vulnerable parents.

KEYWORDS:

decision aid; head trauma; paediatrics; shared decision making

PMID:
31758633
DOI:
10.1111/hex.12965

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