An Assessment of the Shared-Decision Model in Parents of Children with Acute Otitis Media

The authors conducted a cross-sectional survey of 466 parents to determine whether physician style affected (1) parents' proclivity for using antibiotics to treat children's acute otitis media (AOM) and (2) parents' rating of care by the physician. Physician styles were divided into two "shared-decision making" models (SDM) and one "paternalistic." SDM models utilize a newer approach recommended by health care experts as part of a movement away from doctor-centered approaches. AOM accounts for 10 percent of all pediatric visits and in the U.S. results in antibiotic prescription >98 percent of the time. In countries such as the Netherlands, where 31 percent of AOM cases are treated with antibiotics, antibiotic resistance is at 1 percent compared with the U.S.'s 25 percent.

Each parent read a vignette describing a child's diagnosis of AOM and physician recommendation for care. Parents were assigned to three different groups; each group read a slightly different vignette meant to illustrate a patient-doctor style. One vignette was an example of paternalistic medicine (the doctor strongly recommends treatment with antibiotics) and the other were variations on an SDM scenario (parent and doctor deciding on a course of action together). Information about the benefits of waiting to treat AOM was provided in all vignettes. Parents then were asked to imagine themselves being the parent in the vignette and to rate their feelings about the visit as far as information provided and level of satisfaction with the visit.

Key Findings:

  • Parents in the paternalistic group were less satisfied than parents in the two SDM groups.
  • Before reading vignettes, 93 percent agreed that antibiotics were "usually required" to treat AOM with no statistical significance among groups; after reading them, 14 percent agreed that waiting 48 hours and reevaluating was a viable option, with more parents (27% versus 7% ) in the paternalistic group opting for immediate treatment.

A limitation of the study is that vignettes were used rather than actual behaviors. However, the authors state that their findings indicate that education and the use of SDM approaches may succeed in reducing antibiotic usage to treat AOM. Also, the study sample was homogenous, with parents having high education levels and socioeconomic status. However, educated patients and high socioeconomic status patients are more likely to participate in SDM models for patient-doctor interaction.