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Published on: November 6, 2019
Surgeon Information-Sharing, Parent Verbal Engagement, and Parent Knowledge of Pediatric Adenotonsillectomy
Lauren E Claus1, Janine M Amos1, Anne R Links1
1Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins University, Baltimore, Maryland, USA.
Insights
Clinician information-sharing during pediatric adenotonsillectomy consultations improved parent knowledge of obstructive sleep-disordered breathing (OSDB). Increased parent engagement and knowledge reduced decisional conflict, aiding surgical decisions.
Area of Science:
- Pediatric Otolaryngology
- Health Communication
- Patient Decision Making
Background:
- Obstructive sleep-disordered breathing (OSDB) in children often requires adenotonsillectomy.
- Effective communication is crucial for informed parental decision-making regarding pediatric surgery.
- Understanding parent knowledge and engagement is key to improving consultation outcomes.
Purpose of the Study:
- To characterize clinician information-sharing and parent verbal engagement during pediatric adenotonsillectomy consultations.
- To evaluate the relationship between these communication behaviors and parental disease-specific knowledge.
- To assess the impact of parent knowledge and engagement on decisional conflict.
Main Methods:
- Mixed-methods sequential explanatory analysis of audio-recorded outpatient otolaryngology consultations.
- Identification of clinician risk/benefit discussions and parent verbal responses (passive vs. active).
- Post-consultation knowledge questionnaire and qualitative analysis of parent questions.
Main Results:
- Clinician discussion of risks and benefits correlated with increased parent knowledge (OR=3.70).
- Parent active engagement did not significantly correlate with increased knowledge (OR=1.04).
- Higher parent knowledge and active engagement were linked to reduced decisional conflict (OR=0.41 and OR=0.26, respectively).
Conclusions:
- Clinician information-sharing enhances parental knowledge regarding OSDB treatment options.
- Empowering parents through engagement and knowledge leads to decreased decisional conflict.
- Findings can guide clinicians in optimizing counseling strategies for pediatric surgical decisions.
Objective:
We characterize clinician information-sharing and parent verbal engagement during pediatric adenotonsillectomy consultations and evaluate whether these behaviors relate to disease-specific knowledge for parents of children with obstructive sleep-disordered breathing (OSDB).
Study Design:
Mixed-methods sequential explanatory analysis.
Setting:
Outpatient otolaryngology clinics.
Methods:
We analyzed audio-recorded communication during outpatient encounters for children undergoing initial evaluation for adenotonsillectomy. We identified discrete triadic instances of clinician discussion of individual risks and benefits, parent verbal responses coded as passive ("Right") or active ("Would that repeat the recovery time?"), and corresponding parent answer (correct or incorrect) on a postconsult knowledge questionnaire. Primary outcomes included parent knowledge and decisional conflict. We qualitatively analyzed substantive questions asked by parents during the encounter.
Results:
In 30 consults, clinicians (n = 8) provided 156 instances of discussion (101 risk, 55 benefit), to which parents provided 34% active responses. Clinician discussion of risks and benefits was associated with greater parent knowledge (odds ratio [OR] = 3.70, 95% confidence interval [CI]: 2.25-6.09; P < .001), however parent active engagement was not associated with greater parent knowledge (OR = 1.04, 95% CI: 0.42-2.58, P = .93). Parents demonstrated greater knowledge of benefits than risks (χ2 = 23.16, V = 1.13; P < .001). Parents who responded actively (OR = 0.26, 95% CI: 0.09-0.72; P = .010) or had greater knowledge (OR = 0.41, 95% CI: 0.21-0.81; P = .010) had less decisional conflict.
Conclusion:
Clinician information-sharing was associated with greater parent knowledge about OSDB treatment. Greater parent engagement and knowledge were independently associated with less decisional conflict. These findings may inform clinicians' approaches to counseling and engaging parents in decisions for surgery.
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