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

Area of Science:

• Pediatric Gastroenterology
• Clinical Decision Making
• Patient-Centered Care

Background:

• Shared decision making (SDM) is crucial for patient-centered care, especially in managing pediatric inflammatory bowel diseases (IBD).
• The decision to initiate biologic therapies, such as tumor necrosis factor-α inhibitors, requires careful consideration involving patients and physicians.

Purpose of the Study:

• To assess the utilization of SDM among specialists when deciding to start tumor necrosis factor-α inhibitors in pediatric IBD patients.
• To compare physician and practice characteristics, perceived decision components, and barriers/facilitators between SDM users and non-users.
• To explore the influence of SDM on adolescent involvement in treatment decisions.

Main Methods:

• A survey was distributed to specialists regarding their SDM practices for initiating tumor necrosis factor-α inhibitors in pediatric IBD patients.
• Responses were analyzed to compare characteristics and perceptions between physicians who reported using SDM and those who did not.
• Statistical comparisons were made for decision components, barriers, and facilitators.

Main Results:

• Of 209 respondents, 75% reported using SDM.
• No significant differences were found between SDM users and non-users regarding physician/practice characteristics, important decision components, or the number of barriers and facilitators.
• Physicians utilizing SDM showed a greater acceptance of adolescent participation in the decision-making process.

Conclusions:

• Reported barriers and facilitators may not effectively predict or improve SDM implementation in this context.
• Further research is necessary to understand the specific role and impact of adolescent involvement in treatment decisions for pediatric IBD.
• Current interventions aimed at increasing SDM may need re-evaluation, focusing on factors beyond perceived obstacles.