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Parental Decision-Making for Infant Spinal Anesthesia - A Qualitative Study
Audrey Rosenblatt1, Heather Ballard1, Alexander B Froyshteter1
1Ann & Robert H. Lurie Children's Hospital of Chicago.
Insights
Parents
Area of Science:
- Pediatric Anesthesiology
- Medical Decision-Making
- Qualitative Research
Background:
- Spinal anesthesia is a safe alternative to general anesthesia for infant surgeries below the umbilicus.
- Parental decision-making for infant spinal anesthesia versus general anesthesia is complex and not well understood.
- Understanding parental perceptions is crucial for informed consent and shared decision-making.
Purpose of the Study:
- To explore and understand the parental decision-making process for infant spinal anesthesia.
- To identify key factors influencing parents' choices between spinal and general anesthesia for their children.
Main Methods:
- Qualitative study using semi-structured interviews with parents of infants undergoing urologic procedures.
- Interviews conducted pre-operatively to capture contemporaneous decision-making without outcome bias.
- Grounded theory analysis of narrative data; health literacy assessed using the BRIEF tool.
Main Results:
- Key themes influencing decisions included information processing timelines, cooperative decision-making, maternal experiences, perceived invasiveness, and procedural risks (neurotoxicity, respiratory, spinal damage).
- Parental decision-making involves co-parenting and reliance on healthcare provider support.
- Health literacy varied, with 23 participants having adequate and seven marginal literacy.
Conclusions:
- Parental decisions regarding infant spinal anesthesia are multifaceted.
- Providing clear educational materials, adequate time for processing information, and supportive guidance from anesthesia providers are essential for informed parental choices.
- Addressing parental concerns about invasiveness and safety is paramount.
Background:
Spinal anesthesia is a viable alternative to general anesthesia for infant surgical procedures below the umbilicus. However, choosing spinal anesthesia over general anesthesia is a complex medical decision for parents. Little is known about how parents perceive infant spinal anesthesia as an alternative to general anesthesia and how they make this decision for their children.
Aims:
The aim of this research study was to generate a holistic understanding of the parental decision-making process for spinal anesthesia in infants.
Methods:
A qualitative research study was conducted at a single, pediatric tertiary care institution from November 2023 - July 2024. Eligible participants were parents whose infants were scheduled for an outpatient urologic procedure and had been offered a choice between spinal and general anesthesia. Semi-structured interviews were conducted with parents while their child was in the operating room to create a contemporaneous picture of the parental decision-making process without the influence of procedural outcomes. Narrative data was analyzed using a constructivist grounded theory methodology. Health literacy was assessed with the BRIEF screening tool.
Results:
Twenty interviews were conducted with 32 participants - eight individual parent interviews and 12 parent dyads. Qualitative themes included the importance of: 1) the timeline of information attainment and processing, 2) cooperative decision-making with the subthemes of co-parenting and healthcare provider support, 3) the influence of maternal experiences with neuraxial anesthesia, 4) a desire for an anesthetic perceived to be less invasive, and 5) overall procedural risks with subthemes of neurotoxicity, respiratory complications, and spinal damage. Health literacy showed seven participants were marginal and 23 were adequate.
Conclusions:
Infant spinal anesthesia decisions are complex medical decisions for parents. Clear education, mental processing time, and guidance from anesthesia providers help parents make informed decisions.
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