Decision-making by parents and children in paediatric hand surgery

The task of decision-making about microvascular toe-transfer surgery is a complex one for parents and their children. The process involves balancing risks and benefits within the context of the emotional responses of the parents and the future needs of their children. This paper describes a model of clinical practice which incorporates that process through a multi-disciplinary approach. The factors which influenced parents in their decision are examined, and the issue of the competence of the child to participate is discussed. 34 families were assessed, of whom 7 did not proceed with surgery. It was found that parents were more influenced by factors within the process, such as communication, than by concerns about technical outcome. Specialised psychological counselling played an integral role in the making of stable decisions.