Decision aid prototype for treatment of pediatric sleep disordered breathing: A randomized pilot study

Abstract

Objectives: 1) To examine the feasibility and usability of a decision aid prototype (DA) for pediatric obstructive sleep apnea (OSA). 2) to estimate parameters for a future randomized controlled trial.

Study design: Multicenter randomized pilot trial.

Methods: Ninety-nine parents of children ( < 6 years of age) undergoing consultation for adenotonsillectomy for sleep-disordered breathing were prospectively enrolled. Families were randomly assigned to receive the DA or to follow standard care procedures. All consultations were video-recorded and coded with the observing patient involvement in decision making (OPTION) instrument. Following the consultation, parents completed the Decisional Conflict Scale (DCS) and Shared Decision-Making Questionnaire (SDM-Q-9), whereas otolaryngologists completed the physician version (SDM-Q-Doc). A subset of parents and surgeons were interviewed to assess the usability of the DA.

Results: Overall, a significantly negative correlation between DCS and SDM-Q-9 was observed (P < 0.001). Interviews showed that parents found the DA helpful but wanted more time to read and contemplate the information. Both parents and surgeons indicated that instructions on how to use the DA would be beneficial. For parents receiving the DA, the mean total OPTION score was 13.83 out of 40 (standard deviation 5.24), compared to 11.95 (standard deviation 5.21) in those not receiving the DA (P = 0.11). There were no significant differences in the decisional conflict or shared decision making when using the DA.

Conclusion: The DA was feasible but used differently among surgeons. The need to improve SDM techniques was suggested by both surgeons and parents. Future studies training otolaryngologists on effective SDM techniques and how to appropriately utilize decision aids may improve SDM for pediatric OSA.

Level of evidence: 1b Laryngoscope, 129:229-234, 2019.

Keywords: Adenotonsillectomy; decision aid; pediatric obstructive sleep apnea; shared decision making; sleep disordered breathing.