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Development and acceptability of a decision-aid for food allergy oral immunotherapy in children
Aikaterini Anagnostou1, Elissa M Abrams2,3, Melanie Carver4
1Department of Allergy and Immunology, Texas Children's Hospital, Houston, Texas, USA.
Insights
A new decision aid supports shared decision-making for pediatric food oral immunotherapy (OIT). This tool helps families navigate choices about OIT versus avoidance, showing good acceptability and improving confidence.
Area of Science:
- Allergy and Immunology
- Pediatric Medicine
- Decision Science
Background:
- Limited decision-support tools exist for initiating food oral immunotherapy (OIT) in children.
- No current tool comprehensively addresses all food types, OIT forms, and pediatric age ranges.
Purpose of the Study:
- To develop and validate a pediatric decision aid for food oral immunotherapy (OIT) initiation.
- To compare OIT with allergen avoidance, facilitating shared decision-making (SDM).
Main Methods:
- Developed a pediatric decision aid through iterative refinement with experts and stakeholders, adhering to International Patient Decision Aid Standards.
- Incorporated qualitative data on OIT decisional needs and synthesized OIT literature evidence.
- Assessed the tool's acceptability, decisional conflict, and self-efficacy in 135 caregivers.
Main Results:
- The 4-page decision aid (Flesch-Kincaid 6.1) was iteratively developed over 5 stages.
- Caregivers reported good acceptability, high decisional self-efficacy (85.9/100), and low decisional conflict (20.9/100).
- Information was rated adequate and sufficient, with balanced and unbiased therapy choice presentation.
Conclusions:
- The developed pediatric OIT decision aid is the first of its kind, product-agnostic, allergen-agnostic, and age-agnostic.
- The tool demonstrates good acceptability, minimal bias, and is linked to reduced decisional conflict and enhanced self-efficacy.
- It effectively supports shared decision-making for initiating OIT or continuing allergen avoidance.
Background:
Limited decision-support tools are available to help shared decision-making (SDM) regarding food oral immunotherapy (OIT) initiation. No current tool covers all foods, forms, and pediatric ages for which OIT is offered.
Methods:
In compliance with International Patient Decision Aid Standards criteria, this pediatric decision-aid comparing OIT versus avoidance was developed in three stages. Nested qualitative data assessing OIT decisional needs were supplemented with evidence-synthesis from the OIT literature to create the prototype decision-aid content. This underwent iterative development with food allergy experts and patient advocacy stakeholders until unanimous consensus was reached regarding content, bias, readability, and utility in making a choice. Lastly, the tool underwent validated assessment of decisional acceptability, decisional conflict, and decisional self-efficacy.
Results:
The decision-aid underwent 5 iterations, resulting in a 4-page written aid (Flesch-Kincaid reading level 6.1) explaining therapy choices, risks and benefits, providing self-rating for attribute importance for the options and self-assessment regarding how adequate the information was in decision-making. A total of n = 135 caregivers of food-allergic children assessed the decision-aid, noting good acceptability, high decisional self-efficacy (mean score 85.9/100) and low decisional conflict (mean score 20.9/100). Information content was rated adequate and sufficient, the therapy choices wording balanced, and presented without bias for a "best choice." Lower decisional conflict was associated with caregiver-reported anaphylaxis.
Conclusions:
This first pediatric OIT decision-aid, agnostic to product, allergen, and age has good acceptability, limited bias, and is associated with low decisional conflict and high decisional self-efficacy. It supports SDM in navigating the decision to start OIT or continue allergen avoidance.
