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Trade-offs from a family perspective: considerations in choosing between omalizumab and complementary alternative
Hang Chen1, Yan Xu1,2, Jian-Li Qiu1,2
1School of Pediatrics, Henan University of Chinese Medicine, Zhengzhou, Henan, China.
Insights
Families managing pediatric severe asthma face complex choices between biologics and complementary alternative medicine (CAM). Decisions are shaped by quality of life goals, risk perception, treatment burden, and health equity, highlighting the need for family-centered care.
Area of Science:
- Pediatric Pulmonology
- Health Services Research
- Family Medicine
Background:
- Pediatric severe asthma management presents unique challenges for families.
- Families weigh targeted biologics against complementary alternative medicine (CAM), influencing treatment decisions.
- Existing research often overlooks the family's perspective in these complex choices.
Purpose of the Study:
- To systematically analyze factors influencing family decisions between biologics and CAM for pediatric severe asthma.
- To adopt a family-centered perspective in understanding treatment goal alignment, risk perception, treatment burden, and shared decision-making (SDM).
- To identify areas for improving clinical practice and future research in pediatric severe asthma management.
Main Methods:
- Systematic review adopting a family-centered perspective.
- Analysis of key decision-making factors: treatment goals, risk perception, treatment burden, and SDM.
- Examination of how value systems, lived experiences, risk perception patterns, and tolerance for treatment burden shape choices.
Main Results:
- Family decision-making is multidimensional, influenced by values, experiences, risk perception, and treatment burden tolerance.
- Subjective risk assessments, particularly for CAM, dominate due to a lack of comparative risk evidence.
- Treatment burden and health equity significantly impact choices but are often overlooked, hindering effective SDM.
Conclusions:
- Clinical practice must evolve towards family-centered care, addressing real-world needs and optimizing risk communication.
- Routine evaluation of treatment burden and overcoming SDM barriers are crucial for effective pediatric severe asthma management.
- Future research should focus on risk perception evidence gaps, SDM tools, and culturally diverse family needs to promote health equity.
Abstract:
The management of pediatric severe asthma poses significant challenges for families. When faced with the choice between targeted biologics like omalizumab and widely used complementary alternative medicine (CAM), families navigate a complex decision-making process influenced by multiple factors. This review adopts a family-centered perspective to systematically analyze key factors influencing this trade-off: treatment goals (extending beyond clinical metrics to focus on quality of life), risk perception (shaped by subjective constructs and lacking direct evidence for comparative risk assessments), treatment burden (often overlooked hidden costs), and the current state of shared decision-making (SDM). Analysis reveals that family decision-making is a multidimensional construct shaped by four core elements: value systems, lived experiences, risk perception patterns, and tolerance for treatment burden. Notably, the significant gap in risk perception evidence leads to subjective risk assessments dominating decisions, particularly in CAM choices. Treatment burden, a critical hidden cost, is often marginalized in decisions, hindering effective SDM. Health equity further profoundly impacts choices. The conclusion emphasizes the need for clinical practice to shift toward family-centered care by addressing real-world needs, routinely evaluating treatment burden, optimizing risk communication, overcoming SDM barriers, and promoting health equity. Future research must fill evidence gaps in risk perception, develop SDM tools, and address culturally diverse family needs.
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