Decision aid reduces caregivers' preference for acid-suppressive medication in infants with symptoms suggestive of reflux

Caregivers of infants with symptoms suggestive of gastroesophageal reflux (GER), such as regurgitation and excessive crying, often feel uncertain and seek treatment, though it is usually unnecessary. This study evaluated the effect of a decision aid on reducing caregivers' preference for acid suppressive medication for infants referred because of potential GER symptoms and its effect on their decision certainty.

Infants (<18 months) referred to pediatric outpatient clinics with symptoms suggestive of GER were included. The decision aid provided information on gastroesophageal reflux disease (GERD) and three treatment options: lifestyle advice, thickened feeding, and acid-suppressive medication. Caregivers completed questionnaires assessing treatment preference and decision certainty before (T1a) and after using the decision aid (T1b), and after the outpatient visit (T2). Decision certainty was assessed using the Decisional Conflict Scale (DCS).

A total of 110 infants were included (median age 4 months [interquartile range 2-6]; 48% female; 78% general hospital). Pre-visit questionnaires (T1a, T1b) were completed by 79 caregivers (72%) and 53 (48%) also completed T2. Preference for acid-suppressive medication decreased from 46/79 (58%) at T1a to 34/79 (43%) at T1b (p < 0.05), and to 6/53 (11%) at T2 (p < 0.001). Mean DCS-score (scale 0-100) decreased from 47.2 (standard deviation [SD] 16.1) at T1a to 34.4 (SD 17.4) at T1b, and to 19.0 (SD 12.3) post-visit (p < 0.001), indicating improved decision certainty.

The decision aid reduced caregivers' preference for acid-suppressive treatment in infants with symptoms suggestive of GER and increased decision certainty. This supports the potential role of a decision aid in promoting appropriate care.