Using Option Grids: steps toward shared decision-making for neonatal circumcision

• Determining parent preferences is key to good decision making for neonatal circumcision.
• There is evidence to show that clinicians vary in the extent to which they elicit and integrate parental preferences when circumcision is considered.
• Encounter tools such as Option Grids may help facilitate shared decision making.
• This study found that Option Grids supported collaboration between clinicians and parents when comparing treatment alternatives.

ObjectivesTo assess the impact, acceptability and feasibility of a short encounter tool designed to enhance the process of shared decision-making and parental engagement.MethodsWe analyzed video-recordings of clinical encounters, half undertaken before and half after a brief intervention that trained four clinicians how to use Option Grids, using an observer-based measure of shared decision-making. We also analyzed semi-structured interviews conducted with the clinicians four weeks after their exposure to the intervention.ResultsObserver OPTION5 scores were higher at post-intervention, with a mean of 33.9 (SD = 23.5) compared to a mean of 16.1 (SD = 7.1) for pre-intervention, a significant difference of 17.8 (95% CI: 2.4, 33.2). Prior to using the intervention, clinicians used a consent document to frame circumcision as a default practice. Encounters with the Option Grid conferred agency to both parents and clinicians, and facilitated shared decision-making. Clinician reported recognizing the tool’s positive effect on their communication process.ConclusionsTools such as Option Grids have the potential to make it easier for clinicians to achieve shared decision-making.Practice ImplicationsEncounter tools have the potential to change practice. More research is needed to test their feasibility in routine practice.