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Congenital Cardiac Surgery and Parental Perception of Risk: A Quantitative Analysis
Robyn Lotto1, Ian Jones1, Sarah E Seaton2
1Faculty of Health, Liverpool John Moores University, Webster Street, Liverpool, United Kingdom.
Insights
Parents consistently perceive higher risks than clinicians during pediatric cardiac surgery. Maternal risk perception is higher than paternal, and complications increase perceived risk, highlighting a need for tailored parental support.
Area of Science:
- Pediatric Cardiac Surgery
- Parental Risk Perception
- Health Psychology
Background:
- Parental understanding of risks in pediatric cardiac surgery is not well-documented.
- A gap exists between clinician perceptions of parental risk comprehension and parental self-reports of risk perception.
Purpose of the Study:
- To quantify parental risk perception in children undergoing congenital cardiac surgery.
- To compare parental risk perception with objective surgical risk levels.
Main Methods:
- 106 parents completed a 6-point Likert scale assessing perceived risk at 5 time points.
- Surgical risk was stratified using the Risk Adjustment in Congenital Heart Surgery (RACHS) level.
- Statistical analysis included Wilcoxon rank tests and Krippendorff's alpha for agreement.
Main Results:
- Parental risk scores varied over time, showing no consistent pattern.
- Maternal risk perception was consistently higher than paternal perception (P < .001).
- Postoperative complications led to a sustained increase in perceived risk (P < .001), with poor agreement between parental and objective risk, especially at extremes.
Conclusions:
- Parents generally perceive higher surgical risks than healthcare providers.
- Discrepancies in risk perception between mothers and fathers may indicate relationship dynamics.
- Dynamic risk perception underscores the need for adaptive informational and support strategies for parents.
Introduction:
Interpretation of risk by parents of children undergoing congenital cardiac surgery is poorly documented. The available evidence highlights a dichotomy where clinicians suggest parents may not grasp the complexity and risk associated with procedures, while some parents suggest risk is unnecessarily overemphasized.
Aim:
To quantify how risk is perceived by parents.
Methods:
One hundred six parents of children undergoing cardiac surgery were recruited and completed a Likert-type scale from 1 (perceived low risk) to 6 (perceived high risk), at 5 points: arrival at preadmission, post discussion with anethetist/surgeon, day of surgery, discharge from intensive care, and at outpatient follow-up. The surgical sample was stratified according to Risk Adjustment in Congenital Heart Surgery level.
Analysis:
Data were analyzed using Wilcoxon rank tests for differences in distributions of scores and Krippendorff α to examine the level of agreement.
Results:
Median parental risk scores varied over time, with no consistent risk scores observed. Maternal scores were consistently higher than paternal scores at every time point (P < .001). Postoperative complications resulted in a persistent rise in risk perception at follow-up (P < .001). Analysis of parental risk scores and objective measures of surgical risk highlighted poor agreement that was particularly marked at the extremes of risk.
Conclusions:
Parents perceived higher risk scores than those reported by the clinical team. Mothers reported statistically significantly higher scores than their partners, highlighting potential tensions. In addition, the changing perception of risk over time emphasizes the need for flexible levels of support and information as parents navigate uncertainty.
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