Structured shared decision-making using dialogue and visualization: A randomized controlled trial

Objective: The aim of this study is to evaluate a method, "Counseling in Dialogue" (CD), developed to increase the quality of counseling in youth mental health. Decisional conflict was used as indicator of the quality of counseling and shared decision-making. Methods: 94 children aged 2-12 years were randomized into a CD group and a care as usual (CU) group. In a before-and-after design decisional conflict was measured using the decisional conflict scale (DCS) for parents (N = 133) and the Provider Decision Process Assessment Instrument for therapists (PDPAI, N = 20). 81 children had follow-up data. Results: Compared with parents of the CU group, parents of the CD group reported significantly less decisional conflict after counseling (difference mothers: -0.38 (95%CI -0.56; -0.19), p <.001; fathers: -0.22 (95%CI -0.44; -0.01), p = .045). 98% of the mothers and 96% of the fathers in the CD group accepted the recommended treatment, compared to 71% (fathers) and 77% (mothers) in the CU group, p <0.05. Decisional conflict of the therapists was low in both groups after counseling (difference: -0.03 (95%CI -0.19; 0.14), p = .741). Conclusion: The counseling procedure significantly lowered decisional conflict of the parents and promoted the acceptance of the recommended treatment.