Physician perspectives on discussions with parents of infants with suspected ureteropelvic junction obstruction
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Published on: October 12, 2017
Vijaya M Vemulakonda1, Allison Kempe2, Mika K Hamer2
1Department of Pediatric Urology, Children's Hospital Colorado; Division of Urology, Department of Surgery, University of Colorado School of Medicine, Aurora, Colorado, USA.
Insights
Pediatric urologists tailor discussions for infants with suspected UPJ obstruction based on family background and follow-up risk. Evidence-based guidelines could reduce treatment variations.
Area of Science:
- Pediatric Urology
- Health Services Research
Background:
- Infants with suspected ureteropelvic junction (UPJ) obstruction often require surgical consideration.
- Discussions regarding treatment options involve complex factors and parental understanding.
Purpose of the Study:
- To explore pediatric urologists' perceptions of patient characteristics influencing treatment discussions for infants with suspected UPJ obstruction.
- To understand how urologists approach communication with parents regarding surgical and non-surgical management.
Main Methods:
- Semi-structured interviews were conducted with 13 pediatric urologists across three diverse geographical locations.
- Qualitative data analysis employed an inductive grounded theory approach to identify recurring themes.
Main Results:
- Urologists reported standardized communication strategies but tailored discussions based on parental education, cultural background, and language.
- Concerns about loss to follow-up influenced treatment recommendations.
- Physicians acknowledged using personal experience due to a lack of clear clinical data.
Conclusions:
- Pediatric urologists implicitly consider patient and family demographics, particularly educational and language barriers, and follow-up risk.
- A recognized gap in evidence-based data necessitates reliance on personal experience.
- Developing evidence-based guidelines may standardize treatment decisions for UPJ obstruction.
Introduction:
The purpose of this study was to understand pediatric urologists' perceived role of patient characteristics on discussions about treatment of infants with suspected UPJ obstruction.
Methods:
We conducted semi-structured interviews with pediatric urologists from three geographically diverse sites. Interview domains included: clinical indications for surgery, discussions with parents, and consideration of parent socioeconomic factors. Transcribed data and field notes were analyzed using a team-based, inductive grounded theory approach.
Results:
Thirteen physicians were interviewed. Physicians reported a standardized approach to discussions to facilitate parental understanding. While they did not report overt consideration of demographics, they tailored discussions based on educational and cultural background and language barriers. Physicians also reported that concerns about risk of loss to follow up contributed to their treatment recommendations. Most physicians recognized that the lack of clear data often led to use of personal experience to guide recommendations.
Conclusion:
Physicians recognize a gap in data to guide surgical decisions and utilize personal experience to augment this gap. They also recognize the influence of educational and language barriers on discussions with families and consider risk of loss to follow up when making recommendations, suggesting an implicit consideration of demographics. These findings suggest that development of evidence-based guidelines may reduce treatment variations.
Level Of Evidence:
Not applicable (qualitative research study written in compliance with COREQ guidelines).
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