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Shared decision-making for pediatric elective penile surgery
Wyatt MacNevin1, Amanda MacDonald1, Paul Hong2
1Faculty of Medicine, Dalhousie University, Halifax, NS, Canada.
Insights
In pediatric penile surgery, shared decision-making (SDM) was perceived as high, yet 15% of parents experienced decisional conflict (DC) linked to lower SDM involvement, indicating a need for improved communication.
Area of Science:
- Pediatric Surgery
- Urology
- Decision Science
Background:
- Proxy decision-makers in pediatric surgery often face decisional conflict (DC).
- Shared decision-making (SDM) may mitigate DC.
- Elective pediatric penile surgery involves parental decision-making.
Purpose of the Study:
- To investigate decisional conflict (DC) in parents undergoing elective pediatric penile surgery.
- To assess the level of shared decision-making (SDM) involvement during these consultations.
Main Methods:
- Prospective enrollment of 44 parents of children under 8 years old.
- Utilized patient and physician questionnaires for SDM assessment.
- Employed the SURE screening test to evaluate decisional conflict (DC).
Main Results:
- Seven participants (15.9%) experienced significant decisional conflict (DC).
- High average SDM scores were reported by both patients and physicians.
- DC was significantly associated with lower perceived SDM involvement from both parties.
Conclusions:
- High perceived SDM involvement in pediatric penile surgery consultations.
- A notable percentage of parents experienced DC, correlating with reduced SDM.
- Discrepancies in perceived SDM between parents and physicians highlight areas for improvement.
Introduction:
In pediatric surgery, proxy decision-makers are frequently involved in treatment planning and may experience decisional conflict (DC). Shared decision-making (SDM) approaches may be effective to remedy DC. This study investigates DC and SDM involvement in elective pediatric penile surgery.
Methods:
Forty-four parents of children aged <8 years undergoing elective penile surgery consultations at a tertiary pediatric hospital were prospectively enrolled. Patient and physician questionnaires were used to assess the SDM process and the SURE (Sure of myself; Understand information; Risk-benefit ratio; Encouragement) screening test was used to assess DC.
Results:
Thirty-seven (84.1%) mothers and seven (15.9%) fathers were enrolled for circumcision (n=33, 75.0%) and distal hypospadias repair (n=11, 25.0%) consultations, with 21 (47.7%) choosing to proceed with surgery. Seven (15.9%) participants experienced clinically significant DC. Participant gender was not associated with higher levels of DC (p=0.318). The average patient and physician SDM scores were 88.2±10.0 and 85.3±7.4, respectively, with no correlation found between participant and physician perception of SDM involvement (p=0.168, p=0.276). DC was significantly associated with lower participant and physician ratings of SDM.
Conclusions:
There was a high perception of SDM involvement by both parents and pediatric urologists regarding elective penile surgery. Of the 15% of parents experiencing DC, there was an association with lower participant and physician levels of SDM involvement. Despite high SDM scores overall, discrepancies exist between the perceived physician and participant SDM involvement.
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