Family decision-making during access to surgical care for children: A qualitative analysis and conceptual framework

How family decisions impact access to surgical care for children remains poorly understood. Our aims were to examine family decision-making during access to surgical care for children with appendicitis and to derive a novel conceptual model of how families make decisions during this process.

This analysis is part of a prospective, mixed-methods study of children with appendicitis at two tertiary hospitals in the US. We used nested purposive sampling to select caregivers of children with acute appendicitis for interviews to probe for decision-making during access to care. Clinical and demographic data were abstracted from the electronic medical record. We performed qualitative analysis of interview data using thematic analysis and developed a novel conceptual model of decision-making processes when accessing surgical care for children.

Twenty-seven interviews were completed with caregivers, including 12 dyad interviews with children 8-17 years. Participants identified decisional conflicts during "when" and "where" to seek care. Dominant drivers of when to seek care included communication patterns, symptom progression, and behavioral changes. Decisions around where to seek care were influenced by system availability, perceived illness severity, concerns about cost, and health care proximity. Key modifiers included language and prior health experiences.

We identified several key drivers of family decision-making during when and where to seek access to acute surgical care for children. This novel conceptual model can help identify targets for interventions to improve access to surgical care for children.