Experiences and decision making during paediatric transitions to continuous sub-cutaneous insulin infusion (CSII): A mixed method study

Abstract

Objectives We aimed to improve the decision quality and outcomes for families with children or adolescents with diabetes considering continuous sub-cutaneous insulin infusion (CSII). Methods A mixed method study involved three focus groups with youth, parents and clinicians to provide experience information as background to the development of a decision aid (DA). A pre-test (T1) and post-test (T2) evaluation of the DA with a convenience sample of five families considering initiating CSII. Results The focus group data showed that families found the move to CSII to be generally empowering with adolescents engaging with the technology quickly, and that experiential information from others was important in the process. Participants increased their knowledge and decreased decisional conflict after using the DA from T1 to T2. Preferred option measurement indicated that at T1, three participants were ‘unsure’ and two participants’ preferred option was CSII. After exposure to the DA at T2, those who were previously unsure had a preferred option of CSII with a resulting five people with a preferred option of CSII. Conclusions The results from this study suggest that transitioning to CSII for paediatric and adolescent patients and their carers may be assisted by a DA and that participants felt empowered to a make decision regarding CSII when using the PANDANI DA. The quasi-experimental design without randomisation or control group was a study limitation caused by the small number of participants. Expanding this pilot research into a randomised control trial would decrease the threat to validity from other possible explanations for the improvement in decisional conflict, such as nurse educators.