Managing Patient Expectations in Pediatric Weight Management

Managing Expectations in Pediatric Weight Management: A Pilot Study in Focus on a Fitter Future III Hospitals

As part of Children's Hospital Association's Focus on a Fitter Future III Obesity Task Force, this project will target patient and family expectations across the domains of nutrition, physical activity and behavior change/family support as a means of patient engagement and retention in pediatric weight management. This will be a prospective, non-randomized, uncontrolled, single-arm trial for children between 2 and 18 years of age and a parent/guardian, who are starting a pediatric weight management program/clinic in one of the participating centers. The parent/guardian and child if 12 years of age or older receive a survey at the first visit, which asks about their expectations and goals for the visit. This information will then be used as part of clinical care to tailor treatment. After 3 months, the parent/guardian and adolescent, if applicable, will receive a follow up survey asking about their progress in these areas.

Study Overview

• Status: Completed
• Conditions: Obesity
• Intervention / Treatment: Behavioral: Patient Expectations; Behavioral: Patient Expectations

• Study Type: Interventional
• Enrollment (Actual): 405
• Phase: Not Applicable

Contacts and Locations

Study Locations

• United States
  • Colorado
    • Denver, Colorado, United States
      • Children's Hospital, Colorado
  • Connecticut
    • Hartford, Connecticut, United States
      • Connecticut Children's Medical Center
  • Illinois
    • Peoria, Illinois, United States, 61637
      • Children's Hospital of Illinois
  • Kentucky
    • Louisville, Kentucky, United States
      • Kosair Children's Hospital
  • Maryland
    • Baltimore, Maryland, United States, 21209
      • Mt. Washington Pediatric Hospital
  • Massachusetts
    • Boston, Massachusetts, United States, 02115
      • Boston Children's Hospital
  • Michigan
    • Ann Arbor, Michigan, United States
      • C.S. Mott Children's Hospital
    • Grand Rapids, Michigan, United States
      • Helen DeVos Children's Hospital
  • Missouri
    • Kansas City, Missouri, United States
      • CHILDREN'S MERCY HOSPITALS & CLINICS
  • Nebraska
    • Omaha, Nebraska, United States
      • Children's Hospital and Medical Center, Omaha
  • Ohio
    • Columbus, Ohio, United States
      • Nationwide Children's Hospital
  • Oregon
    • Portland, Oregon, United States
      • Doernbecher Children's Hospital OHSU

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: 2 years to 18 years (Child, Adult)
• Accepts Healthy Volunteers: No
• Genders Eligible for Study: All

Description

Inclusion Criteria:

• Subject conversant in English or Spanish
• Parent/guardian conversant in English or Spanish
• Patient aged 2-18 years

Exclusion Criteria (For Adolescent):

• Parent-reported cognitive issues preventing completion of the form, such as in-school aide>50% of the school day; special education classes >50% of school day

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Health Services Research
• Allocation: N/A
• Interventional Model: Single Group Assignment
• Masking: None (Open Label)

Number of Arms

1

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
Experimental: Patient Expectations; At the family's initial visit to the pediatric weight management program/clinic each parent/guardian and adolescent (if age 12 yrs. or older) will complete the survey tool. At 3 months, families will be asked to complete a follow up survey. This will be fielded at a visit for those returning to clinic or by phone/mail for those not returning.	Behavioral: Patient Expectations; Baseline Expectations survey (parent/guardian and adolescents 12 and older); Behavioral: Patient Expectations; 3 month follow up survey (parent/guardian and adolescents 12 and older)

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Attrition at 3 months	Defined for treatment clinics (i.e., no set end point) as attending an initial appointment but no further appointments in a 3 month period. For treatment programs (i.e., set end point), attrition is defined as attending <25% of visits in a 3 month period	3 months

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Congruence of learning needs and achieved outcomes	Defined as a match between the identified most important treatment expectation in each of the domains at baseline and the most helpful treatment domains at 3 months. Congruent = at least 4 out 6 possible matches.	3 months

Other Outcome Measures

Outcome Measure	Measure Description	Time Frame
Matched expectations between parent and child expectations at baseline	match between the identified most important treatment expectation in each of the domains at baseline for the parent and adolescent (age 12+). Matched= at least 4 out 6 possible matches.	Baseline
Child BMI Z-score	Change in BMI z-score between baseline and 3 month follow-up	Baseline, 3 months
Provider Satisfaction	Providers will complete a brief survey at the end of the recruitment phase to solicit general feedback and to assess the tool's utility and impact on clinical flow.	3 months
Participation Rate	Proportion of patients who enrolled among those invited to participate.	Baseline

Collaborators and Investigators

• Sponsor: Boston Children's Hospital
• Collaborators: Children's Hospital Colorado; Nationwide Children's Hospital; University of Nebraska; C.S. Mott Children's Hospital; Norton Healthcare; Connecticut Children's Medical Center; Helen DeVos Children's Hospital; Mt. Washington Pediatric Hospital; Children's Hospital of Illinois; OHSU Doernbecher Children's Hospital
• Investigators: Study Chair: Erinn Rhodes, MD, MPH, Boston Children's Hospital; Study Chair: Sarah Hampl, MD, CHILDREN'S MERCY HOSPITALS & CLINICS

Publications and helpful links

General Publications

• Hampl S, Demeule M, Eneli I, Frank M, Hawkins MJ, Kirk S, Morris P, Sallinen BJ, Santos M, Ward WL, Rhodes E. Parent perspectives on attrition from tertiary care pediatric weight management programs. Clin Pediatr (Phila). 2013 Jun;52(6):513-9. doi: 10.1177/0009922813482515. Epub 2013 Mar 28. Erratum In: Clin Pediatr (Phila). 2014 Mar;53(3):NP1.
• Sallinen Gaffka BJ, Frank M, Hampl S, Santos M, Rhodes ET. Parents and pediatric weight management attrition: experiences and recommendations. Child Obes. 2013 Oct;9(5):409-17. doi: 10.1089/chi.2013.0069. Epub 2013 Sep 12.
• Rhodes ET, Boles RE, Chin K, Christison A, Testa EG, Guion K, Hawkins MJ, Petty CR, Sallinen Gaffka B, Santos M, Shaffer L, Tucker J, Hampl SE. Expectations for Treatment in Pediatric Weight Management and Relationship to Attrition. Child Obes. 2017 Apr;13(2):120-127. doi: 10.1089/chi.2016.0215. Epub 2017 Jan 16.

Study record dates

Study Major Dates

• Study Start: January 1, 2013
• Primary Completion (Actual): December 1, 2013
• Study Completion (Actual): December 1, 2013

Study Registration Dates

• First Submitted: December 17, 2012
• First Submitted That Met QC Criteria: December 17, 2012
• First Posted (Estimate): December 20, 2012

Study Record Updates

• Last Update Posted (Estimate): December 17, 2013
• Last Update Submitted That Met QC Criteria: December 16, 2013
• Last Verified: December 1, 2013

More Information

Terms related to this study

• Keywords: Adolescents; Obesity; Children; Attrition
• Additional Relevant MeSH Terms: Overnutrition; Nutrition Disorders; Overweight; Body Weight; Obesity
• Other Study ID Numbers: P00006045