Pediatric Caregiver Version of the Shared Decision Making Process Scale: Validity and Reliability for ADHD Treatment Decisions
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K D Valentine1, Ellen A Lipstein2, Ha Vo3
1Division of General Internal Medicine (KD Valentine, H Vo, MJ Barry, and K Sepucha), Massachusetts General Hospital, Boston; Harvard Medical School (KD Valentine and K Sepucha), Boston, Mass.
Insights
This study validated a scale measuring shared decision making (SDM) for pediatric attention-deficit/hyperactivity disorder (ADHD) treatment, finding it reliable and useful for assessing caregiver involvement in ADHD medication decisions.
Area of Science:
- Pediatric Healthcare
- Clinical Psychology
- Health Services Research
Background:
- Shared decision making (SDM) is crucial for pediatric care but lacks validated measures.
- Attention-deficit/hyperactivity disorder (ADHD) treatment decisions require effective SDM tools.
Purpose of the Study:
- Adapt and validate the SDM Process scale for caregivers of children with ADHD.
- Assess the scale's reliability and validity in the context of ADHD medication decisions.
Main Methods:
- Cross-sectional survey of 498 caregivers of children (5-13 years) with ADHD.
- Utilized the adapted SDM Process scale, decisional conflict, decision regret, and involvement measures.
- Assessed test-retest reliability on a subset of participants.
Main Results:
- The adapted scale demonstrated good acceptability and reliability (ICC=0.74).
- Convergent validity was supported by associations with decisional conflict and decision involvement.
- Higher SDM scores correlated with less decision regret.
Conclusions:
- The adapted Pediatric Caregiver SDM Process scale is acceptable, valid, and reliable for ADHD medication decisions.
- Findings suggest pediatricians generally involve caregivers in these decisions.
Objective:
Shared decision making (SDM) is recommended for common pediatric conditions; however, there are limited data on measures of SDM in pediatrics. This study adapted the SDM Process scale and examined validity and reliability of the scale for attention-deficit/hyperactivity disorder (ADHD) treatment decisions.
Methods:
Cross-sectional survey of caregivers (n = 498) of children (aged 5-13) diagnosed with ADHD, who had made a decision about ADHD medication in the last 2 years. Surveys included the adapted SDM Process scale (scores range 0-4, higher scores indicate more SDM), decisional conflict, decision regret, and decision involvement. Validity was assessed by testing hypothesized relationships between these constructs. A subset of participants was surveyed a week later to assess retest reliability.
Results:
Pediatric Caregiver version of the SDM Process scale (M = 2.8, SD = 1.05) showed no evidence of floor or ceiling effects. The scale was found to be acceptable (<1% missing data) and reliable (intraclass correlation coefficient = 0.74). Scores demonstrated convergent validity, as they were higher for those without decisional conflict than those with decisional conflict (2.93 vs 2.46, P < .001, d = 0.46), and higher for caregivers who stated they made the decision with the provider than those who made the decision themselves (3.0 vs 2.7; P = .003). Higher scores were related to less regret (r = -0.15, P < .001), though the magnitude of the relationship was small.
Conclusions:
The adapted Pediatric Caregiver version of the SDM Process scale demonstrated acceptability, validity and reliability in the context of ADHD medication decisions made by caregivers of children 5-13. Scores indicate pediatricians generally involve caregivers in decision making about ADHD medication.
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