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Development and acceptability of a decision‐aid for food allergy oral immunotherapy in children

Wiley
Allergy
Authors:
  • Texas Children's Hospital & Baylor College of Medicine
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Abstract

Background Limited decision‐support tools are available to help shared decision‐making (SDM) regarding food oral immunotherapy (OIT) initiation. No current tool covers all foods, forms, and pediatric ages for which OIT is offered. Methods In compliance with International Patient Decision Aid Standards criteria, this pediatric decision‐aid comparing OIT versus avoidance was developed in three stages. Nested qualitative data assessing OIT decisional needs were supplemented with evidence‐synthesis from the OIT literature to create the prototype decision‐aid content. This underwent iterative development with food allergy experts and patient advocacy stakeholders until unanimous consensus was reached regarding content, bias, readability, and utility in making a choice. Lastly, the tool underwent validated assessment of decisional acceptability, decisional conflict, and decisional self‐efficacy. Results The decision‐aid underwent 5 iterations, resulting in a 4‐page written aid (Flesch–Kincaid reading level 6.1) explaining therapy choices, risks and benefits, providing self‐rating for attribute importance for the options and self‐assessment regarding how adequate the information was in decision‐making. A total of n = 135 caregivers of food‐allergic children assessed the decision‐aid, noting good acceptability, high decisional self‐efficacy (mean score 85.9/100) and low decisional conflict (mean score 20.9/100). Information content was rated adequate and sufficient, the therapy choices wording balanced, and presented without bias for a “best choice.” Lower decisional conflict was associated with caregiver‐reported anaphylaxis. Conclusions This first pediatric OIT decision‐aid, agnostic to product, allergen, and age has good acceptability, limited bias, and is associated with low decisional conflict and high decisional self‐efficacy. It supports SDM in navigating the decision to start OIT or continue allergen avoidance.
Allergy. 2025;80:205–214.
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205wileyonlinelibrary.com/journal/all
Received: 5 July 2024 
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Revised: 19 August 2024 
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Accepted: 29 Augus t 2024
DOI : 10.1111/all.16 332
ORIGINAL ARTICLE
Food Allergy and Gastrointestinal Disease
Development and acceptability of a decision- aid for food
allergy oral immunotherapy in children
Aikaterini Anagnostou1| Elissa M. Abrams2,3 | Melanie Carver4| Edmond S. Chan5|
Sanaz Eftekhari4| Justin Greiwe6,7| Hannah Jaffee4| Jay A. Lieberman8|
Douglas P. Mack9| S. Shahzad Mustafa10 | Marcus S. Shaker11,12| David Stukus13|
Julie Wang14| Matthew Greenhawt15
1Depar tment of Allerg y and Immunolog y, Texas Childre n's Hospital, Houston, Texas, USA
2Depar tment of Pediatrics and Child Health, University of Manitoba, Winnipeg, Manitoba, C anada
3Depar tment of Pediatrics, Sectio n of Allergy and Clinical Immunology, University of Manitoba, W innipeg, Manitoba, Canada
4The Asthma and Allergy Foundation of A meric a, Arlington, Virginia, USA
5Division of Aller gy, Department of Pediatrics, BC Children's Hospital, University of British Columbia, Vancouver, British Columbia, Canada
6Bernstein Allergy G roup, Inc., Cincinnati, Ohio, USA
7Division of Immunology/Allergy Section, Department of Internal Medicine, The Univer sity of C incinnati College of Medicine, Cincinnati, Ohio, USA
8The University of Tennessee Health Science Center, Memphis, Tennessee, USA
9Depar tment of Pediatrics, McMaster University, Hamilton, Ontario, Canada
10Roche ster Regional He alth, University of Rocheste r School of Medicine and Dentistry, Rochester, New York, USA
11Dartmouth Hitchcock Medical Center, Section of Allergy and Clinical Immunology, Lebanon, New Hampshire, USA
12Geisel School of Medicine at Dart mouth, Hanover, New Hampshire, USA
13Division of Allergy an d Immunology, Nationwide Children's Hospital, Columbus, Ohio, USA
14The Division of Allerg y and Immunolog y, Depar tment of Pediatrics, Icahn School of Medicine at Mount Sinai, Jaffe Food Allergy Institute, New York, New
York, USA
15Section of Allergy and Clinic al Immunolog y, Children's Hospit al Colorado, University of Colorado School of Medicine, Aurora, Colorado, USA
© 2024 European Acad emy of Allergy and Clinical Immunolog y and John Wiley & S ons Ltd.
Abbreviations: AAFA, A sthma and Alle rgy Foundati on of America; D CS, De cision Conflic t Scale; DSE, D ecisional Sel f- Efficac y Scale; FDA, Fo od and Drug Admi nistration; I PDAS,
Intern ationa l Patient D ecisio n Aid Stand ards; IQR , inter quar tile ran ge; OIT, oral imm unothe rapy; SD , stand ard deviat ion; SDM , shared de cision ma king.
Correspondence
Matthew Greenhawt , Section of Allergy
and Immunolog y, Children's Hospit al
Colorado, Universit y of Colorado School
of Medicine, 13123 E. 16th Ave , Aurora,
CO 800 45, USA .
Email: matthew.greenhawt@
childrenscolorado.org
Abstract
Background: Limited decision- support tools are available to help shared decision-
making (SDM) regarding food oral immunotherapy (OIT) initiation. No current tool
covers all foods, forms, and pediatric ages for which OIT is offered.
Methods: In compliance with International Patient Decision Aid Standards criteria,
this pediatric decision- aid comparing OIT versus avoidance was developed in three
stages. Nested qualitative data assessing OIT decisional needs were supplemented
with evidence- synthesis from the OIT literature to create the prototype decision- aid
content. This underwent iterative development with food allergy experts and patient
advocacy stakeholders until unanimous consensus was reached regarding content,
bias, readability, and utility in making a choice. Lastly, the tool underwent validated
assessment of decisional acceptability, decisional conflict, and decisional self- efficacy.
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