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296 Baseline measurement of shared decision-making with chronically ill children in the Maldives
  1. Ricardo O Wijngaarde1,
  2. Faisal Ahmed2,
  3. Reema Mujey2,
  4. Shelna Aisath3,
  5. Dirk T Ubbink1
  1. 1Department of Surgery, Amsterdam University Medical Centers, Amsterdam, The Netherlands
  2. 2Department of Paediatric Care, Indira Gandhi Memorial Hospital, Malé, Maldives
  3. 3Maldivian Blood Services, Malé, Maldives

Abstract

Introduction Shared decision-making (SDM) is a burgeoning concept of care in the Maldives. Also paediatric SDM with chronically ill children is still a novelty, although many treatment decisions are made over time. We conducted a baseline measurement of the level of SDM in a paediatric outpatient clinic at the Indira Gandhi Memorial Hospital.

Methods Children with a chronic disease visiting the paediatric outpatient clinic were studied after informed consent. Two evaluators independently analysed audio-recordings of the consultations to score the level of patient involvement, using the OPTION-5 instrument. Patients (or parents) were asked to complete the SDM-Q-9 and paediatricians the SDM-Q-Doc questionnaires and were expressed as percentage of the maximum score. No paediatrician received previous SDM-training.

Results Twenty-four consultations were audiotaped, six per paediatrician. Children’s ages ranged from 0 to 15 years. Patients’ median SDM-Q-9 scores were 43% (Inter-Quartile Range [IQR] 39.5–46.5%).

Physicians’ median SDM-Q-Doc scores were 35.5% ([IQR] 29.6–41.4%). Mean OPTION-5 score was 19.2% (SD 7.5%).

Discussion These preliminary results suggest that in the Maldives, SDM is rarely observed among paediatricians and children suffering from chronic diseases and their parents. Insufficient knowledge of the benefits of SDM as well as the novelty of SDM techniques are likely reasons for the low subjective and objective SDM-scores found.1 2

Conclusions The low SDM-scores in this baseline study were as expected, but offer opportunities to introduce this method of care in the Maldives in an area where SDM seems an obvious approach when deciding about treatment options.3 4 SDM can and will be improved nationally through education about the benefits of SDM, training to strengthen paediatricians’ SDM- and risk-communication skills and interventions to help children and parents participate in the decision-making process.5–7

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