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Front. Endocrinol. | doi: 10.3389/fendo.2018.00688

Shared Decision-Making in Growth Hormone Therapy – Implications for Patient Care

  • 1University of Cambridge, United Kingdom
  • 2Department of Paediatrics and Child Health, University of the Witwatersrand, South Africa
  • 3Department of Endocrinology, University Hospitals Birmingham NHS Foundation Trust, United Kingdom
  • 4Department of Pediatrics and Developmental Biology, Tokyo Medical and Dental University, Japan
  • 5Novo Nordisk (Switzerland), Switzerland
  • 6Istituto Giannina Gaslini (IRCCS), Italy

Several studies have shown that adherence to growth hormone therapy (GHT) is not optimal. There are several reasons why patients may not fully adhere to their treatment regimen and this may have implications on treatment success, patient outcomes and healthcare spending and resourcing. A change in healthcare practices, from a physician paternalistic to a more patient autonomous approach to healthcare, has encouraged a greater onus on a shared decision-making (SDM) process whereby patients are actively encouraged to participate in their own healthcare decisions. There is growing evidence to suggest that SDM may facilitate patient adherence to GHT and in doing so, improve treatment outcomes. Whilst SDM is widely regarded as a healthcare imperative, there is little guidance on how it should be best implemented. Despite this, there are many opportunities for the implementation of SDM during the treatment journey of a patient with a GH-related disorder including but not limited to selecting the GH product. Barriers to the successful practice of SDM within the clinic may include poor patient education surrounding their condition and treatment options, limited healthcare professional time, lack of support from clinics to use SDM and healthcare resourcing restrictions. Here we discuss the opportunities for the implementation of SDM and the barriers that challenge its effective use within the clinic. We also review some of the potential solutions to overcome these challenges that may prove key to effective patient participation in treatment decisions. Encouraging a sense of empowerment for patients will ultimately enhance treatment adherence and improve clinical outcomes in GHT.

Keywords: Growth hormone therapy, Delivery device, Patient autonomy, Treatment Adherence, Shared decision-making (SDM)

Received: 30 Jul 2018; Accepted: 02 Nov 2018.

Edited by:

Indraneel (Indi) Banerjee, University of Manchester, United Kingdom

Reviewed by:

Ronald Cohen, Pritzker School of Medicine, University of Chicago, United States
Tim Cheetham, Newcastle University, United Kingdom  

Copyright: © 2018 Acerini, Segal, Criseno, Takasawa, Nedjatian, Rohrich and Maghnie. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.

* Correspondence: Dr. C L. Acerini, University of Cambridge, Cambridge, United Kingdom,