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Understanding shared decision making in pediatric otolaryngology
Jill Chorney1, Rebecca Haworth2, M Elise Graham2
1IWK Health Centre, Halifax, Nova Scotia, Canada Division of Otolaryngology-Head and Neck Surgery, Department of Surgery, Dalhousie University, Halifax, Nova Scotia, Canada Department of Anesthesia, Pain Management and Perioperative Medicine, Dalhousie University, Halifax, Nova Scotia, Canada.
Insights
Many parents experience significant decisional conflict when deciding on pediatric surgery. Increased involvement in shared decision making reduces this conflict, though parent and physician perceptions differ.
Area of Science:
- Pediatric Surgery
- Decision Science
- Healthcare Management
Background:
- Parental involvement in pediatric surgical decisions is crucial.
- Understanding decisional conflict is key to improving patient and family experiences.
- Shared decision making (SDM) aims to involve patients and families in healthcare choices.
Purpose of the Study:
- To assess decisional conflict in parents considering surgery for their children.
- To examine the relationship between decisional conflict and perceptions of shared decision making.
Main Methods:
- Prospective cohort study in an academic pediatric otolaryngology clinic.
- 65 parents of children undergoing elective surgery completed questionnaires on SDM and decisional conflict.
- Surgeons also completed a physician version of the SDM questionnaire.
Main Results:
- 16.9% of parents reported significant decisional conflict (Decisional Conflict Scale > 25).
- Higher perceived involvement in shared decision making correlated with lower decisional conflict.
- Parent and physician perceptions of SDM were unrelated, and physician ratings did not correlate with parental decisional conflict.
Conclusions:
- A notable proportion of parents face significant decisional conflict regarding pediatric surgery.
- Enhancing parents' perceived involvement in shared decision making may mitigate decisional conflict.
- Discrepancies in SDM perceptions between parents and physicians warrant further investigation and intervention.
Objective:
The aim of this study was to describe the level of decisional conflict experienced by parents considering surgery for their children and to determine if decisional conflict and perceptions of shared decision making are related.
Study Design:
Prospective cohort study.
Setting:
Academic pediatric otolaryngology clinic.
Subjects And Methods:
Sixty-five consecutive parents of children who underwent surgical consultation for elective otolaryngological procedures were prospectively enrolled. Participants completed the Shared Decision Making Questionnaire and the Decisional Conflict Scale. Surgeons completed the Shared Decision Making Questionnaire-Physician version.
Results:
Eleven participants (16.9%) scored over 25 on the Decisional Conflict Scale, a previously defined clinical cutoff indicating significant decisional conflict. Parent years of education and parent ratings of shared decision making were significantly correlated with decisional conflict (positively and negatively correlated, respectively). A logistic regression indicated that shared decision making but not education predicted the presence of significant decisional conflict. Parent and physician ratings of shared decision making were not related, and there was no correlation between physician ratings of shared decision making and parental decisional conflict.
Conclusions:
Many parents experienced considerable decisional conflict when making decisions about their child's surgical treatment. Parents who perceived themselves as being more involved in the decision-making process reported less decisional conflict. Parents and physicians had different perceptions of shared decision making. Future research should develop and assess interventions to increase parents' involvement in decision making and explore the impact of significant decisional conflict on health outcomes.
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