What is the effect of a decision aid in potentially vulnerable parents? Insights from the head CT choice randomized trial

Rachel M. Skains; Nathan Kuppermann; James L. Homme; Anupam B. Kharbanda; Leah Tzimenatos; Jeffrey P. Louie; Daniel M. Cohen; Lise E. Nigrovic; Jessica J. Westphal; Nilay D. Shah; Jonathan Inselman; Michael J. Ferrara; Jeph Herrin; Victor M. Montori; Erik P. Hess

doi:10.1111/hex.12965

What is the effect of a decision aid in potentially vulnerable parents? Insights from the head CT choice randomized trial

Rachel M. Skains, Nathan Kuppermann, James L. Homme, Anupam B. Kharbanda, Leah Tzimenatos, Jeffrey P. Louie, Daniel M. Cohen, Lise E. Nigrovic, Jessica J. Westphal, Nilay D. Shah, Jonathan Inselman, Michael J. Ferrara, Jeph Herrin, Victor M. Montori, Erik P. Hess

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Abstract

Objective: To test the hypotheses that use of the Head CT Choice decision aid would be similarly effective in all parent/patient dyads but parents with high (vs low) numeracy experience a greater increase in knowledge while those with low (vs high) health literacy experience a greater increase in trust. Methods: This was a secondary analysis of a cluster randomized trial conducted at seven sites. One hundred seventy-two clinicians caring for 971 children at intermediate risk for clinically important traumatic brain injuries were randomized to shared decision making facilitated by the DA (n = 493) or to usual care (n = 478). We assessed for subgroup effects based on patient and parent characteristics, including socioeconomic status (health literacy, numeracy and income). We tested for interactions using regression models with indicators for arm assignment and study site. Results: The decision aid did not increase knowledge more in parents with high numeracy (P for interaction [P_int] = 0.14) or physician trust more in parents with low health literacy (P_int = 0.34). The decision aid decreased decisional conflict more in non-white parents (decisional conflict scale, −8.14, 95% CI: −12.33 to −3.95; P_int = 0.05) and increased physician trust more in socioeconomically disadvantaged parents (trust in physician scale, OR: 8.59, 95% CI: 2.35-14.83; P_int = 0.04). Conclusions: Use of the Head CT Choice decision aid resulted in less decisional conflict in non-white parents and greater physician trust in socioeconomically disadvantaged parents. Decision aids may be particularly effective in potentially vulnerable parents.

Original language	English (US)
Pages (from-to)	63-74
Number of pages	12
Journal	Health Expectations
Volume	23
Issue number	1
DOIs	https://doi.org/10.1111/hex.12965
State	Published - Feb 1 2020

Bibliographical note

Funding Information:
Funding information Research reported in this publication was funded through a Patient-Centered Outcomes Research Institute (PCORI) Award (Contract 12-11-4435). The views presented in this publication are solely the responsibility of the author(s) and do not necessarily represent the views of the Patient-Centered Outcomes Research Institute (PCORI), its Board of Governors or Methodology Committee. We thank the patients and clinicians who participated in our trial and all other contributors.

Publisher Copyright:
© 2019 The Authors Health Expectations published by John Wiley & Sons Ltd

Keywords

decision aid
head trauma
paediatrics
shared decision making

UN SDGs

This output contributes to the following UN Sustainable Development Goals (SDGs)

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10.1111/hex.12965

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Skains, R. M., Kuppermann, N., Homme, J. L., Kharbanda, A. B., Tzimenatos, L., Louie, J. P., Cohen, D. M., Nigrovic, L. E., Westphal, J. J., Shah, N. D., Inselman, J., Ferrara, M. J., Herrin, J., Montori, V. M., & Hess, E. P. (2020). What is the effect of a decision aid in potentially vulnerable parents? Insights from the head CT choice randomized trial. Health Expectations, 23(1), 63-74. https://doi.org/10.1111/hex.12965

Skains, RM, Kuppermann, N, Homme, JL, Kharbanda, AB, Tzimenatos, L, Louie, JP, Cohen, DM, Nigrovic, LE, Westphal, JJ, Shah, ND, Inselman, J, Ferrara, MJ, Herrin, J, Montori, VM & Hess, EP 2020, 'What is the effect of a decision aid in potentially vulnerable parents? Insights from the head CT choice randomized trial', Health Expectations, vol. 23, no. 1, pp. 63-74. https://doi.org/10.1111/hex.12965

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title = "What is the effect of a decision aid in potentially vulnerable parents? Insights from the head CT choice randomized trial",

abstract = "Objective: To test the hypotheses that use of the Head CT Choice decision aid would be similarly effective in all parent/patient dyads but parents with high (vs low) numeracy experience a greater increase in knowledge while those with low (vs high) health literacy experience a greater increase in trust. Methods: This was a secondary analysis of a cluster randomized trial conducted at seven sites. One hundred seventy-two clinicians caring for 971 children at intermediate risk for clinically important traumatic brain injuries were randomized to shared decision making facilitated by the DA (n = 493) or to usual care (n = 478). We assessed for subgroup effects based on patient and parent characteristics, including socioeconomic status (health literacy, numeracy and income). We tested for interactions using regression models with indicators for arm assignment and study site. Results: The decision aid did not increase knowledge more in parents with high numeracy (P for interaction [Pint] = 0.14) or physician trust more in parents with low health literacy (Pint = 0.34). The decision aid decreased decisional conflict more in non-white parents (decisional conflict scale, −8.14, 95% CI: −12.33 to −3.95; Pint = 0.05) and increased physician trust more in socioeconomically disadvantaged parents (trust in physician scale, OR: 8.59, 95% CI: 2.35-14.83; Pint = 0.04). Conclusions: Use of the Head CT Choice decision aid resulted in less decisional conflict in non-white parents and greater physician trust in socioeconomically disadvantaged parents. Decision aids may be particularly effective in potentially vulnerable parents.",

keywords = "decision aid, head trauma, paediatrics, shared decision making",

author = "Skains, {Rachel M.} and Nathan Kuppermann and Homme, {James L.} and Kharbanda, {Anupam B.} and Leah Tzimenatos and Louie, {Jeffrey P.} and Cohen, {Daniel M.} and Nigrovic, {Lise E.} and Westphal, {Jessica J.} and Shah, {Nilay D.} and Jonathan Inselman and Ferrara, {Michael J.} and Jeph Herrin and Montori, {Victor M.} and Hess, {Erik P.}",

note = "Funding Information: Funding information Research reported in this publication was funded through a Patient-Centered Outcomes Research Institute (PCORI) Award (Contract 12-11-4435). The views presented in this publication are solely the responsibility of the author(s) and do not necessarily represent the views of the Patient-Centered Outcomes Research Institute (PCORI), its Board of Governors or Methodology Committee. We thank the patients and clinicians who participated in our trial and all other contributors. Publisher Copyright: {\textcopyright} 2019 The Authors Health Expectations published by John Wiley & Sons Ltd",

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doi = "10.1111/hex.12965",

language = "English (US)",

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T1 - What is the effect of a decision aid in potentially vulnerable parents? Insights from the head CT choice randomized trial

AU - Skains, Rachel M.

AU - Kuppermann, Nathan

AU - Homme, James L.

AU - Kharbanda, Anupam B.

AU - Tzimenatos, Leah

AU - Louie, Jeffrey P.

AU - Cohen, Daniel M.

AU - Nigrovic, Lise E.

AU - Westphal, Jessica J.

AU - Shah, Nilay D.

AU - Inselman, Jonathan

AU - Ferrara, Michael J.

AU - Herrin, Jeph

AU - Montori, Victor M.

AU - Hess, Erik P.

N1 - Funding Information: Funding information Research reported in this publication was funded through a Patient-Centered Outcomes Research Institute (PCORI) Award (Contract 12-11-4435). The views presented in this publication are solely the responsibility of the author(s) and do not necessarily represent the views of the Patient-Centered Outcomes Research Institute (PCORI), its Board of Governors or Methodology Committee. We thank the patients and clinicians who participated in our trial and all other contributors. Publisher Copyright: © 2019 The Authors Health Expectations published by John Wiley & Sons Ltd

PY - 2020/2/1

Y1 - 2020/2/1

N2 - Objective: To test the hypotheses that use of the Head CT Choice decision aid would be similarly effective in all parent/patient dyads but parents with high (vs low) numeracy experience a greater increase in knowledge while those with low (vs high) health literacy experience a greater increase in trust. Methods: This was a secondary analysis of a cluster randomized trial conducted at seven sites. One hundred seventy-two clinicians caring for 971 children at intermediate risk for clinically important traumatic brain injuries were randomized to shared decision making facilitated by the DA (n = 493) or to usual care (n = 478). We assessed for subgroup effects based on patient and parent characteristics, including socioeconomic status (health literacy, numeracy and income). We tested for interactions using regression models with indicators for arm assignment and study site. Results: The decision aid did not increase knowledge more in parents with high numeracy (P for interaction [Pint] = 0.14) or physician trust more in parents with low health literacy (Pint = 0.34). The decision aid decreased decisional conflict more in non-white parents (decisional conflict scale, −8.14, 95% CI: −12.33 to −3.95; Pint = 0.05) and increased physician trust more in socioeconomically disadvantaged parents (trust in physician scale, OR: 8.59, 95% CI: 2.35-14.83; Pint = 0.04). Conclusions: Use of the Head CT Choice decision aid resulted in less decisional conflict in non-white parents and greater physician trust in socioeconomically disadvantaged parents. Decision aids may be particularly effective in potentially vulnerable parents.

AB - Objective: To test the hypotheses that use of the Head CT Choice decision aid would be similarly effective in all parent/patient dyads but parents with high (vs low) numeracy experience a greater increase in knowledge while those with low (vs high) health literacy experience a greater increase in trust. Methods: This was a secondary analysis of a cluster randomized trial conducted at seven sites. One hundred seventy-two clinicians caring for 971 children at intermediate risk for clinically important traumatic brain injuries were randomized to shared decision making facilitated by the DA (n = 493) or to usual care (n = 478). We assessed for subgroup effects based on patient and parent characteristics, including socioeconomic status (health literacy, numeracy and income). We tested for interactions using regression models with indicators for arm assignment and study site. Results: The decision aid did not increase knowledge more in parents with high numeracy (P for interaction [Pint] = 0.14) or physician trust more in parents with low health literacy (Pint = 0.34). The decision aid decreased decisional conflict more in non-white parents (decisional conflict scale, −8.14, 95% CI: −12.33 to −3.95; Pint = 0.05) and increased physician trust more in socioeconomically disadvantaged parents (trust in physician scale, OR: 8.59, 95% CI: 2.35-14.83; Pint = 0.04). Conclusions: Use of the Head CT Choice decision aid resulted in less decisional conflict in non-white parents and greater physician trust in socioeconomically disadvantaged parents. Decision aids may be particularly effective in potentially vulnerable parents.

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KW - head trauma

KW - paediatrics

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What is the effect of a decision aid in potentially vulnerable parents? Insights from the head CT choice randomized trial

Abstract

Bibliographical note

Keywords

UN SDGs

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