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Parents' Perspectives on Communication and Shared Decision Making for Febrile Infants ≤60 Days Old
Paul L Aronson, Paula Schaeffer1, Linda M Niccolai2
1From the Departments of Pediatrics and of.
Insights
Parents of febrile infants need clear information for better understanding and trust. Shared decision-making (SDM) for procedures like lumbar puncture (LP) is valuable, but parental preferences vary.
Area of Science:
- Pediatric Emergency Medicine
- Health Communication
- Shared Decision Making
Background:
- Febrile infants under 60 days old often require medical evaluation.
- Management decisions for these infants can be complex.
- Shared decision making (SDM) may improve care for febrile infants.
Purpose of the Study:
- To explore parents' experiences receiving information in the emergency department (ED).
- To understand parents' perspectives on SDM for febrile infants, including lumbar puncture (LP).
Main Methods:
- Semistructured interviews with 23 parents of febrile infants (≤60 days old).
- Interviews conducted in a pediatric ED at an urban academic medical center.
- Thematic analysis of interview transcripts using the constant comparative method.
Main Results:
- Lack of information negatively affected parental understanding, stress, and trust.
- Parents desire opportunities to voice opinions, with varying preferences for decision-making involvement.
- Perceptions of risk influenced parental preferences regarding lumbar puncture (LP).
Conclusions:
- Physicians must provide adequate information to foster parental understanding and trust.
- SDM is appropriate for decisions like lumbar puncture (LP) in febrile infants.
- Parental preferences for participation in medical decision-making differ significantly.
Objectives:
Decisions about the management of febrile infants ≤60 days old may be well suited for shared decision making (SDM). Our objectives were to learn about parents' experiences with receiving and understanding information in the emergency department (ED) and their perspectives on SDM, including for decisions about lumbar puncture (LP).
Methods:
We conducted semistructured interviews with 23 parents of febrile infants ≤60 days old evaluated in the pediatric ED at an urban, academic medical center. Interviews assessed parents' experiences in the ED and their perspectives on communication and SDM. Two investigators coded the interview transcripts, refined codes, and identified themes using the constant comparative method.
Results:
Parents' unmet need for information negatively impacted parents' understanding, stress, and trust in the physician. Themes for parents' perspectives on SDM included the following: (1) giving parents the opportunity to express their opinions and concerns builds confidence in the decision making process, (2) parents' preferences for participation in decision making vary considerably, and (3) different perceptions about risks influence parents' preferences about having their infant undergo an LP. Although some parents would defer decision making to the physician, they still wanted to be able to express their opinions. Other parents wanted to have the final say in decision making. Parents valued risks and benefits of having their child undergo an LP differently, which influenced their preferences.
Conclusions:
Physicians need to adequately inform parents to facilitate parents' understanding of information and gain their trust. Shared decision making may be warranted for decisions about whether to perform an LP, although parents' preferences for participating in decision making vary.
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