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Parents' vs physicians' utilities (values) for clinical outcomes in potentially bacteremic children
M S Kramer1, A M MacLellan, A Ciampi
1Department of Pediatrics, McGill University Faculty of Medicine, Montreal, Quebec, Canada.
Insights
Physicians and parents differ in valuing outcomes for febrile infants. Parents place higher disutility on interventions like blood draws and hospitalization, influencing clinical decision-making for fever management in children.
Area of Science:
- Pediatric Decision Analysis
- Clinical Economics
- Health Outcomes Research
Background:
- Previous analyses suggested risks of routine blood cultures in febrile infants outweigh benefits.
- Parental values for clinical outcomes informed prior decision analyses.
- Physician values may differ, potentially altering conclusions regarding blood culture utility.
Purpose of the Study:
- To compare physician and parent values for clinical outcomes in young children with fever.
- To determine if value differences between physicians and parents impact decision analysis results for blood cultures.
Main Methods:
- Surveyed 121 parents and 57 physicians using a linear analog utility scale.
- Evaluated eight potential clinical outcomes for potentially bacteremic children (3-24 months).
- Analyzed utilities using a statistical model, normalizing values from 0 (worst) to 1 (best).
Main Results:
- Both parents and physicians combined outcome components non-linearly.
- Parents assigned significantly lower utility (higher disutility) to venipuncture, hospitalization, and minor infection compared to physicians.
- Parents with other children at home assigned even lower utilities to adverse outcomes.
Conclusions:
- Parental values regarding the disutility of interventions differ from physicians'.
- These value differences are substantial enough to potentially alter the conclusions of decision analyses.
- Clinical guidelines for managing fever in young children should consider these differing stakeholder values.
Abstract:
Our previous analyses of decision strategies in children 3-24 months with acute-onset fever greater than or equal to 39 degrees C and no evident bacterial focus of infection indicated that the risks of routine blood cultures (the unnecessary hospitalization and treatment of children who clear their bacteremia spontaneously) outweigh its benefits (the prevention of a few cases with major infectious sequelae). Because those analyses were based on parents' values for beneficial and adverse clinical outcomes, we wished to examine whether those values differed in physicians and, if so, whether the differences were sufficient to change the results of the decision analysis. Using a pre-tested linear analog utility (value) scale, we evaluated eight potential clinical outcomes in potentially bacteremic children by surveying 121 parents of healthy 3-24-month-old children attending a private pediatric group practice and 57 attending physicians of a tertiary-care children's hospital emergency room. Utilities were based on a 0-1 normalization, where 0 is the utility of the worst outcome (meningitis or other major bacterial infection, plus venipuncture), and 1 the utility of the best outcome (complete recovery without venipuncture or hospitalization), and were analyzed using a recently developed statistical model of utility. The majority of parents and physicians combined the imputed components of the outcomes (disease, pain of venipuncture, and stress of hospitalization) in a nonlinear fashion. Parents assigned substantially lower utility (i.e. greater disutility) to venipuncture, minor infection, and hospitalization than did physicians, and these utilities were even lower in parents with other children at home.(ABSTRACT TRUNCATED AT 250 WORDS)