The Role of Shared Decision Making in Pediatric Food Allergy Management

Abstract

Shared decision making was first highlighted in a report by the Institute of Medicine in 2001. The primary aim of this initiative was to improve the quality of care provided to patients in the United States by creating a health care system that is safe, effective, efficient, and equitable. Currently, medical decision making is based on a patient-centered approach, with the individual's preferences, needs, and values guiding optimal care. Patients are frequently faced with various treatment choices with no absolute guarantee of any desired outcome and no clear indication of the "best or least worse" option. In fact, in healthcare, each of these options usually has potential trade-offs and outcomes. The process of how to choose a particular option becomes a discussion where the clinician and the patient have to jointly review the medical evidence, but also the patient's openness and preference for balancing particular attributes of the treatment (both positive and negative). Shared decision making is important for chronic diseases that require long-term management, such as most allergic conditions, including food allergies. The landscape of food allergies has changed considerably in recent years with multiple and significant scientific advances in both diagnostics and treatment, providing an ideal field for the use of shared decision making. For the purposes of this review, we will discuss different areas of food allergy management within a single complex case, focusing on the role of shared decision making.

Keywords: Anaphylaxis; Early introduction; Epicutaneous immunotherapy; Oral food challenge; Oral immunotherapy; Patient-centered care; Peanut allergy; Preference-sensitive care; Shared decision making; Skin prick testing; Values clarification.