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Incorporating patient preferences into practice guidelines: management of children with fever without source
P I Oppenheim1, G Sotiropoulos, L J Baraff
1UCLA School of Medicine.
Insights
Parents often prefer less invasive treatments for febrile infants, even if it means a higher risk of adverse outcomes. Key factors include avoiding painful tests and unnecessary antibiotics.
Area of Science:
- Pediatric healthcare
- Clinical decision-making
- Patient preferences
Background:
- Fever without source is common in young children.
- Treatment decisions involve balancing risks and benefits.
- Understanding parental preferences is crucial for effective care.
Purpose of the Study:
- To evaluate parent preferences for managing young children with fever without source.
- To identify factors influencing parental treatment choices.
Main Methods:
- Parents of children under 36 months were interviewed in a pediatric clinic.
- A case scenario with two treatment options, including risks, outcomes, and costs, was presented.
- Parental preferences for alternative treatment strategies were assessed.
Main Results:
- All parents identified the strategy with a higher risk of adverse outcomes.
- 71% chose less testing and treatment despite increased risk, citing fewer painful procedures, less waiting time, and reduced antibiotic use.
- Cost was a factor for 32% of parents; demographics did not influence preferences.
Conclusions:
- Parental preferences for less invasive management strategies are significant.
- These preferences should be considered in clinical decision-making for febrile infants and children.
Study Objective:
To evaluate parent preferences for the therapy of young children with fever without source.
Participants:
Consecutive parents, not in a medical profession, of children less than 36 months old.
Setting:
Pediatric clinic of a university teaching hospital.
Design:
During individual interviews at the time of their child's clinic visit, parents were presented with a case scenario and two treatment options and the risks, outcomes, and cost associated with each.
Main Outcome Measure:
Parent preferences for alternative treatment strategies.
Results:
All parents correctly identified the management strategy with the higher probability of an adverse outcome. Seventy-one percent chose the option with less testing and treatment and the greater risk of an adverse outcome. Parents' reasons for this choice were fewer painful tests and procedures (36%), less time waiting (32%), smaller chance of unnecessary antibiotics (23%), and ability to return if their child's condition deteriorated (22%). Thirty-two percent of parents indicated that cost was a factor in their decision. Age, gender, education, and/or number of children was not associated with parents' treatment preferences.
Conclusion:
Parents' preferences may be considered when determining how to manage febrile infants and children.