Shared decision making and behavioral impairment a national study among children with special health care needs 英文参考文献.docVIP

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Shared decision making and behavioral impairment a national study among children with special health care needs 英文参考文献.doc

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Shared decision making and behavioral impairment a national study among children with special health care needs 英文参考文献

Fiksetal.BMCPediatrics2012,12:153 /1471-2431/12/153 RESEARCH ARTICLE OpenAccess Shareddecisionmakingandbehavioral impairment:anationalstudyamongchildren withspecialhealthcareneeds AlexanderGFiks1,2,3,4,5*,StephanieMayne3,4,ARussellLocalio6,ChrisFeudtner3,4,5,EvalineAAlessandrini7 andJamesPGuevara1,3,4,5 Abstract Background:TheInstituteofMedicinehasprioritizedshareddecisionmaking(SDM),yetlittleisknownaboutthe impactofSDMovertimeonbehavioraloutcomesforchildren.Thisstudyexaminedthelongitudinalassociationof SDMwithbehavioralimpairmentamongchildrenwithspecialhealthcareneeds(CSHCN). Method:CSHCNaged5-17yearsinthe2002-2006MedicalExpenditurePanelSurveywerefollowedfor2years.The validatedColumbiaImpairmentScalemeasuredimpairment.SDMwasmeasuredwith7itemsaddressingthe4 componentsofSDM.Themainexposureswere(1)themeanlevelofSDMacrossthe2studyyearsand(2)the changeinSDMoverthe2years.Usinglinearregression,wemeasuredtheassociationofSDMandbehavioral impairment. Results:Among2,454subjectsrepresenting10.2millionCSHCN,SDMincreasedamong37%ofthepopulation, decreasedamong36%andremainedunchangedamong27%.ForCSHCNimpairedatbaseline,thechangeinSDM wassignificantwitheach1-pointincreaseinSDMovertimeassociatedwitha2-pointdecreaseinimpairment(95% CI:0.5,3.4),whereasthemeanlevelofSDMwasnotassociatedwithimpairment.Incontrast,amongthosebelow theimpairmentthreshold,themeanlevelofSDMwassignificantwitheachonepointincreaseinthemeanlevelof SDMassociatedwitha1.1-pointdecreaseinimpairment(0.4,1.7),butthechangewasnotassociatedwith impairment. Conclusion:AlthoughthechangeinSDMmaybemoreimportantforchildrenwithbehavioralimpairmentand themeanlevelovertimeforthosebelowtheimpairmentthreshold,resultssuggestthatboththechangeinSDM andthemeanlevelmayimpactbehavioralhealthforCSHCN. Keywords:ChildrenwithSpecialHealthCareNeeds,Communication,Decision-Making Background knowledge, decreasing uncertainty, and pairing families Shared decision making (SDM) is defined as the active withtreatmentstheyfindmostacceptable[2],theI