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Needs assessment of parents for a patient decision aid in pediatric interval appendectomy via the qualitative
Viviane Grandpierre1, Katherine Duba2, Karine Toupin April3
1Surgery, Children's Hospital of Eastern Ontario, Ottawa, Ontario, Canada.
Insights
Parents of children with perforated appendicitis need a patient decision aid (PDA) due to treatment uncertainty. This aid should clarify evidence and values, with formats like pamphlets or electronic resources being preferred.
Area of Science:
- Pediatric Surgery
- Health Decision Science
Background:
- Appendicitis is a common pediatric surgical diagnosis.
- Non-operative management of perforated appendicitis offers two options: interval appendectomy (IA) or expectant management.
- Parents face decisional conflict regarding these treatment choices.
Purpose of the Study:
- To assess parents' need for a patient decision aid (PDA) for perforated appendicitis treatment options.
- To determine parent preferences for PDA format and distribution.
Main Methods:
- Utilized Coulter's systematic development process for PDAs.
- Conducted semi-structured individual interviews with 12 caregivers of children admitted for perforated appendicitis (2019-2020).
Main Results:
- Parents reported significant decisional conflict stemming from a lack of evidence on optimal treatment.
- A strong need for a PDA was identified to aid in clarifying information and parent values with practitioners.
- Parents expressed preferences for various PDA formats (pamphlet, electronic) and delivery timings (admission, discharge, follow-up).
Conclusions:
- Findings underscore a critical need for a patient decision aid to support parents in making informed choices about perforated appendicitis management.
- Addressing parental decisional conflict requires evidence-based tools and clear communication with healthcare providers.
Objectives:
Appendicitis is one of the most commonly encountered pediatric surgical diagnoses, with non-operative management of perforated appendicitis leading to two treatment options: an interval appendectomy (IA) or expectant management. The primary objective of this study was to assess parents' need for a patient decision aid (PDA) among parents considering IA or expectant management. A secondary objective was to determine parent preferences for the format and distribution plan of a drafted patient decision aid.
Methods:
Coulter's systematic development process for PDA was used to guide the assessment interviews for parents. Participants included caregivers of a patient who experienced perforated appendicitis, and admission between 2019 and 2020. Semi-structured individual interviews were conducted to collect information about decision-making needs of parents of children who experienced perforated appendicitis.
Results:
A total of 12 different parents participated in the interviews. Results indicate decisional conflict associated with the lack of evidence for optimal treatment, supporting the need for the development of a patient decision aid to assist in clarifying information and parent values with practitioners. Parents clearly identified a need for evidence to support decision-making in various formats (eg, pamphlet or electronic). Timing of when to deliver the PDA varied (ie, during hospital admission, at discharge, or at follow-up appointment).
Conclusion:
Results indicated various factors contributing to parental decisional conflict, including the lack of evidence showing the optimal treatment, the need for more information, and guidance from practitioners. Overall, findings indicate a strong need for a patient decision aid.
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