Association of a Video Patient Decision Aid with Shared Decision-Making in the Setting of Undescended Testicle Consult
Michael Atwell, MD1, Zachary Pfeifer, MD2, Luke Bidikov, MD1, Gemma Beltran, MD3, Carter Sevick, MD3, Vijaya Vemulakonda, MD4.
1University of Colorado, Aurora, CO, USA, 2University of Utah, Salt Lake City, UT, USA, 34 Adult and Child Consortium for Outcomes Research and Delivery Science, Aurora, CO, USA, 4Children's Hospital of Colorado, Aurora, CO, USA.
Background: Patient-centered care and shared decision-making (SDM) have been identified as key components to improve patient care and outcomes. While patient decision aids have been shown to improve SDM, their use in pediatric urology has not been well-studied. Undescended testicle (UDT) is one of the most common pediatric urologic problems and a source of confusion for parents when deciding when to treat, when to observe, and when nothing needs to be done. This study measures parents’ perceptions about the SDM process and evaluates whether an educational video can improve the SDM process.
Methods: New patients presenting to a tertiary pediatric urology clinic visit with a referral diagnosis of UDT were eligible for the study. Patients with a prior history of UDT surgery were excluded. Patients were randomly assigned to an intervention group where an education video on UDT was shown and a control group that did not see the educational video. Both English and Spanish speaking parents/caregivers of eligible patients in both the control and intervention groups were provided with the previously validated SDM-Q-9 survey consisting of 9 questions with responses provided on a 0-5 Likert Scale. Patients were excluded if they did not answer 2 or more questions on the survey. Descriptive statistics were performed on the group and analyses of differences were performed with Kruskal-Wallis Tests. The variable sdm9 is the sum of responses multiplied by 20/9, so max score is 100 (per survey).
Results: This questionnaire was administered to 153 guardians. 92 guardians were randomly assigned to the intervention group and 61 were randomly assigned to the control group.. In total, the educational video group showed a statistically significant greater understanding and higher quality of shared decision making than the control group (SDM9 Total, p=0.05, Table 1). There were three individual questions that were significantly improved in the educational video group. The first was “My doctor helped me understand all the information” (p=0.036, Table 1), the second was “My doctor and I thoroughly weighed the treatment options” (p=0.036, Table 1), and the third was “My doctor and I selected a treatment option together” (p=0.05, Table 1)
Conclusion: In parents of children referred for UDT, use of an educational video prior to discussions about treatment increased the understanding of the parents and the quality of the share decision making process. Further work is needed to understand the role of video education in increasing understanding and engagement in SDM.
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