Related Experiment Video
Updated: Aug 19, 2026
A Postoperative Evaluation Guideline for Computer-Assisted Reconstruction of the Mandible
Published on: January 28, 2020
Factors influencing shared decision-making in microtia reconstruction: A systematic review
Agnes Q Zhu1, Sophie E Yu1, Kimberly Luu1
1University of California, Department of Otolaryngology, 2233 Post Street, Third Floor, San Francisco, CA, 94115, USA.
Background:
The decision to pursue microtia reconstruction is highly personalized, requiring shared decision-making (SDM). This systematic review analyzes patient and caregiver motivations and priorities guiding the SDM process to help inform clinician-led discussions.
Methods:
A systematic review evaluated studies from 1/1/1990 to 4/25/2025. Included articles focused on SDM in pediatric microtia reconstruction. Descriptive analyses were performed.
Results:
Five articles met criteria, including 235 study participants: 69 patients (ages 3 to 17 at time of surgery), 134 caregivers, and 32 healthcare providers. Key themes were aggregated into a convergence table and given a score (out of 10) representing the strength of convergence of the theme across studies. Various conflicting factors influenced timing of surgery. Fear of social stigma (convergence score: 8/10) and negative psychosocial impacts (8/10) motivated early intervention. Prioritizing patient involvement in decision-making led to delaying surgery. Child involvement in decision-making ranged from unilateral parental decision-making to waiting until patients could make the decision for themselves. Patient motivations for surgery were driven by the negative impacts of microtia (6/10). However, some children highlighted positive aspects and argued that concern for bullying should not influence the decision to pursue surgery (5/10). Microtia patients desired involvement in the SDM process and believed patient preferences should drive decision-making (5/10). However, patients acknowledged the impact of parental influence and had difficulty recalling pre-operative information they had received as a child (4/10). Both patients and caregivers lacked clarity on when children could make informed decisions and how to involve them.
Conclusions:
Though caregivers significantly influence the SDM process regarding ear reconstruction, microtia patients desire to be heavily involved in treatment decisions. Further research regarding age at which children can assent and SDM tools could benefit this patient population.
