Shared Decision Making (SDM) is an interactive process whereby the clinician-patient-parent triad arrives at a treatment decision after reviewing treatment goals, best available medical evidence and patient and parent preferences. SDM tools have been shown to improve patients’ risk perception and knowledge of treatment in both adult and pediatric settings. However, the role of these decision aides in childhood rheumatologic diseases has not been well established. Our objective was to investigate the impact of ‘JIA Medication Choice Cards,’ an SDM tool developed by Pediatric Rheumatology Care and Outcome Improvement Network (PR-COIN) on parent and patient involvement in treatment decisions in adolescents with JIA.

Methods:

Patients diagnosed with JIA (using International League of Associations for Rheumatology criteria) between the ages 12 and 17 were enrolled if they required change or addition of disease modifying drugs. Medication Choice Cards were used to facilitate decision making and discussion in the case group. The cards were not used in the control group. Anonymous survey responses from all patient-parent dyads were used to measure and analyze the following:

1. CollaboRATE (a fast and frugal patient and parent-reported measure of shared decision making, scored 0-9 on a Likert scale):

• Q1: Effort made to help parent/patient understand health issues.
• Q2: Effort made to listen to patient and parent primary health concerns.
• Q3 Effort made to include the primary health concerns in choosing next treatment step.

1. Parental SURE questions (a four item, binary screening measure of decisional conflict)
2. Patients’ actual decision roles (Likert scale)
3. Patients’ preferred decision role (Likert scale)

Statistical analysis included mean + standard deviation (SD). Fisher’s Exact Test and t-test were used to compare results between case and control groups. Statistical significance was defined as p<0.05

Results:

Patient-parent encounter-based dyads were divided in the cases (Medication Choice Cards were used, n=30) and controls (No Medication Choice Cards used, n=16).

Table 1: Patient-perceived decision roles in case and control groups

p=0.0003

Use of medication choice cards was associated with significantly higher number of patients reporting actual SDM compared to the control group with no medication choice cards. Overall, the patients in the case group demonstrated significantly greater autonomy in making treatment decisions (Table-1)

Patient and parent CollaboRATE measures (Q1-Q3) and parental decisional conflict (SURE measures) were not significantly different between case and control groups.

Conclusion:

Ours is the first study to show that use of Medication Choice Cards significantly enhanced shared decision making in treatment of adolescents with JIA, through increased patient engagement. Parent satisfaction and decisional conflict remained unchanged regardless of use of Choice Cards.