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

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. Address correspondence and reprint requests to Hilary K. Michel, MD, UPMC Children's Hospital of Pittsburgh, 4401 Penn Ave., Pediatric Gastroenterology, 3rd Floor, Pittsburgh, PA 15220 (e-mail: hilary.michel2@upmc.edu). Received 13 August, 2018 Accepted 4 October, 2018 Sources of Funding: Data collection was funded by grant #K23HD073149 from the Eunice Kennedy Shriver National Institute of Child Health & Human Development to Dr. Lipstein. Conflicts of Interest: None declared. Supplemental digital content is available for this article. Direct URL citations appear in the printed text, and links to the digital files are provided in the HTML text of this article on the journal's Web site (www.jpgn.org). © 2018 by European Society for Pediatric Gastroenterology, Hepatology, and Nutrition and North American Society for Pediatric Gastroenterology,

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