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Shared decision making and behavioral impairment: a national study among children with special health care needs

Alexander G Fiks1, Stephanie Mayne, A Russell Localio

  • 1The Pediatric Research Consortium (PeRC), The Children's Hospital of Philadelphia, Philadelphia, PA 19104, USA. fiks@email.chop.edu

BMC Pediatrics
|September 25, 2012
PubMed

Insights

Shared decision making (SDM) impacts children with special health care needs (CSHCN). Changes in SDM improved behavioral impairment, while consistent SDM benefited those without impairment.

Area of Science:

  • Pediatrics
  • Health Services Research
  • Child Psychology

Background:

  • Shared decision making (SDM) is a priority, but its long-term effects on child behavioral outcomes are understudied.
  • This research investigates the longitudinal relationship between SDM and behavioral impairment in children with special health care needs (CSHCN).

Purpose of the Study:

  • To examine the longitudinal association between shared decision making (SDM) and behavioral impairment in children with special health care needs (CSHCN).

Main Methods:

  • Longitudinal analysis of 2,454 children with special health care needs (CSHCN) aged 5-17 years from the 2002-2006 Medical Expenditure Panel Survey over two years.
  • Behavioral impairment measured using the Columbia Impairment Scale; SDM assessed via a 7-item scale covering four components.
  • Linear regression used to analyze the association between mean SDM levels, changes in SDM, and behavioral impairment.

Main Results:

  • Among 10.2 million CSHCN, SDM increased for 37%, decreased for 36%, and remained stable for 27%.
  • For CSHCN with baseline impairment, a 1-point increase in SDM over time correlated with a 2-point decrease in impairment (95% CI: 0.5, 3.4).
  • For CSHCN below the impairment threshold, a 1-point increase in mean SDM correlated with a 1.1-point decrease in impairment (95% CI: 0.4, 1.7).

Conclusions:

  • Changes in SDM appear more critical for improving behavioral impairment in affected children.
  • The mean level of SDM over time is significant for children not yet exhibiting impairment.
  • Both the change and mean level of SDM may influence the behavioral health of CSHCN.
Abstract

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