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Non-Physiologic Factors Sway Growth Hormone Decisions

Doctors' initiation decisions conform to guidelines; continuation decisions driven by other factors

TUESDAY, Aug. 31 (HealthDay News) -- Physicians' decisions to initiate growth hormone (GH) therapy in children with idiopathic short stature are mostly consistent with established guidelines, but their recommendations regarding GH continuation are more strongly influenced by contextual and attitudinal factors than by growth response to therapy, according to research published online Aug. 30 in Pediatrics.

J.B. Silvers, Ph.D., of Case Western Reserve University in Cleveland, and colleagues used a national census study of 727 pediatric endocrinologists to assess how physicians decide to initiate, intensify, or terminate GH treatment in patients with idiopathic short stature.

The investigators found that, in previously untreated children, recommendations to start GH treatment were in line with guidelines and affected by family preferences and physician attitudes. Among children treated with GH, the recommendation to continue GH treatment was dependent on growth response, but there were differences regarding course of action. In children with identical growth responses to GH treatment, independent, non-physiologic, and contextual factors drove physician decisions. The researchers determined that continuation decisions were influenced more by contextual and attitudinal factors than by growth response to therapy.

"With a potential market of 500,000 U.S. children and costs exceeding $10 billion per year, changes in GH use may depend on potentially modifiable physician attitudes and family preferences as much as physiologic evidence," the authors write.

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