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Effects of a Patient Activation Tool on Decision Making Between Surgery and Nonoperative Management for Pediatric

Peter C Minneci1, Jennifer N Cooper1, Karen Leonhart1

  • 1Center for Surgical Outcomes Research, The Research Institute at Nationwide Children's Hospital, Columbus, Ohio.

JAMA Network Open
|June 8, 2019
PubMed

Insights

A patient activation tool (PAT) did not improve decision-making for pediatric appendicitis treatment. However, both groups showed high engagement, indicating effective shared decision-making in acute care settings.

Area of Science:

  • Pediatric Surgery
  • Health Informatics
  • Patient Engagement

Background:

  • Shared decision-making (SDM) is crucial in acute care for pediatric patients and caregivers.
  • Activating patients and caregivers in SDM may improve health outcomes.
  • Appendicitis management offers a choice between surgery and nonoperative treatment, necessitating informed decisions.

Purpose of the Study:

  • To evaluate if a patient activation tool (PAT) enhances decision-making and patient-centered outcomes.
  • To assess PAT's impact on pediatric patients and caregivers choosing between surgery and nonoperative management for appendicitis.

Main Methods:

  • A single-blind, randomized clinical trial involving 200 children (7-17 years) with appendicitis.
  • Participants were randomized to either a standardized surgical consultation or the consultation plus a tablet-based PAT.
  • Outcomes measured included decisional self-efficacy, healthcare satisfaction, and disability days at 1-year follow-up.

Main Results:

  • The PAT did not significantly improve immediate decisional self-efficacy (P=.03) compared to the standard group.
  • Healthcare satisfaction and 1-year disability days were similar between the PAT and standard consultation groups.
  • Treatment choices (surgery vs. nonoperative) and nonoperative management failure rates were comparable between groups.

Conclusions:

  • A technology-based PAT did not demonstrably improve decision-making measures for pediatric appendicitis.
  • High overall scores in both groups suggest successful information processing and SDM capability in acute care.
  • Further research may explore optimizing technology for SDM in urgent pediatric care settings.
Abstract

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