Published online December 1, 2005
PEDIATRICS Vol. 116 No. 6 December 2005, pp. 1267-1275 (doi:10.1542/peds.2005-0486)
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An Assessment of the Shared-Decision Model in Parents of Children With Acute Otitis Media

Dan Merenstein, MD*, Marie Diener-West, PhD*,{ddagger},§, Alex Krist, MD||, Matthew Pinneger, MA, BA and Lisa A. Cooper, MD, MPH§,#,**,{ddagger}{ddagger}

* Robert Wood Johnson Clinical Scholars Program
# Department of Medicine, Johns Hopkins School of Medicine, Baltimore, Maryland
{ddagger}{ddagger} Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins University, Baltimore, Maryland
{ddagger} Departments of Biostatistics
§ Epidemiology
** Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
|| Department of Family Medicine, Fairfax Family Practice Residency, Virginia Commonwealth University, Richmond, Virginia
George Washington University School of Medicine, Washington, DC

Objective. Medicine is shifting from a doctor-centered approach to a model entailing more shared decision-making. Many organizations now recommend a shared-decision approach to treating children with acute otitis media (AOM). Our primary objectives in this study were to assess (1) which style of decision-making on the physician's part would most effectively reduce parents' proclivity to use antibiotics for treatment of their child's AOM and (2) parental satisfaction with different doctor-patient decision-making styles.

Methods. We conducted a cross-sectional survey to examine how parents respond to doctor-patient communication styles in 3 clinical vignettes that presented 2 versions of a shared-decision model (SDM) and 1 paternalistic model. Parents were randomly assigned to receive 1 of 3 vignettes. The main predictor variable was the vignette assignment, and the main outcomes were (1) parent proclivity to use antibiotics and (2) parent ratings of care by the physician in the vignette. Using logistic regression, we adjusted for caregivers' age, gender, income, knowledge of antibiotics, decision-making preference, confidence in physician, and length of relationship with personal physician.

Results. Four hundred sixty-six parents met inclusion criteria, with a response rate of 94%. General characteristics were similar across vignette assignment groups. Parents who received the paternalistic-model vignettes were more likely to say that they would use antibiotics than those who received the SDM vignettes (odds ratio: 4.9; 95% confidence interval: 2.3–10.6). This result remained statistically significant after adjustment for potential confounders. In addition, parents in the shared-decision groups were more satisfied (93% and 84%) than those in the paternalistic-model group (76%).

Conclusions. To our knowledge, this is the first study to examine parent interest, acceptance, and satisfaction with the SDM. Our findings suggest that shared decision-making for AOM may lead to less antibiotic usage and higher levels of parental satisfaction. Although more studies are needed to examine how best to incorporate parents in the SDM, our study serves as an example of the potential benefit of this approach in pediatric medicine.

Key Words: shared decision-making • acute otitis media • patient-centered care • doctor-patient communication

Abbreviations: SDM, shared-decision model • AOM, acute otitis media • SNAP, safety-net antibiotic prescription

Accepted May 2, 2005.




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