Assessment of Parental Choice Predisposition for Tonsillectomy in Children

Abstract

The decision to proceed with tonsillectomy to treat pediatric obstructive sleep-disordered breathing (OSDB) often falls on individual families. Despite emphasis on shared decision-making between parents and surgeons about tonsillectomy for OSDB, the extent to which parents have already decided about surgery prior to the child's consultation is not known.OBJECTIVE To identify predictors of parent choice predisposition for surgical treatment of OSDB with tonsillectomy and describe its association with parent-clinician communication.DESIGN, SETTING, AND PARTICIPANTS Observational cohort study conducted at 3 outpatient clinical sites (urban-based outpatient center, suburban off-site outpatient center, and community-based medical center) associated with a large academic center. A total of 149 parents of children undergoing their initial otolaryngology consultation for OSDB were identified through clinic scheduling records and deemed eligible for participation in this study. Of the 149 parents, a volunteer sample of 64 parents (42.9%) agreed to participate and have their consultation audiorecorded. Of these 64 participants, 12 parents were excluded because their child had previously been evaluated for OSDB by a specialist. MAIN OUTCOMES AND MEASURESThe primary outcomes and measures were treatment choice predisposition scale (a measure of the strength of a patient's treatment decision prior to entering a medical consultation), parent communication behaviors coded in consultation audiorecordings (substantive questions asked, introduced medical jargon, expression of treatment preference, and scores on the OSDB and Adenotonsillectomy Knowledge Scale for parents).RESULTS A total of 52 parent participants were included in the final analysis. Most parent participants were female (n = 48; 92%); 50% (n = 26) of parents were non-Hispanic White, 37% (n = 19) were Black, 10% (n = 5) were Hispanic/Latino, and 4% (n = 2) self-reported race/ethnicity as "Other." Mean (range) choice predisposition was 6.84 (2-10), with 22 parents (42%) more predisposed to choose tonsillectomy. Parents more predisposed to choose tonsillectomy used more medical jargon during the consultation (odds ratio [OR], 3.95; 95% CI, 1.16-15.15) and were less likely to ask questions (OR, 0.22; 95% CI, 0.05-0.87). Parental predictors of greater predisposition toward choosing surgery were White race (OR, 7.31; 95% CI,) and prior evaluation by a pediatrician for OSDB (OR, 6.10; 95% CI,. CONCLUSIONS AND RELEVANCEIn this cohort study of parents of children with OSDB, many parents were predisposed to choose treatment with tonsillectomy prior to initial surgical consultation, which may lessen engagement and influence 2-way communication. In this cohort, greater predisposition for tonsillectomy was observed in non-Hispanic White parents and parents of patients who had been previously evaluated by a pediatrician for OSDB. Understanding parent choice predisposition for surgery may promote improved communication and parental engagement during surgical consultations. It may ...

Awareness and Perceptions of the Impact of Tonsillectomy on the Level of Immunity and Autoimmune Diseases among the Adult Population in Abha City, Kingdom of Saudi Arabia

“…However, there is more susceptibility to sleep apnea before surgical removal of tonsils, which is also associated with increased scores on the post-consultation obstructive sleep disorders breathing and adenotonsillectomy knowledge score (OR, 4.07; 95% CI: 1.17 to 16.17) [ 34 ].…”

Parental Experiences With Access to Care for Obstructive Sleep‐Disordered Breathing: A Qualitative Study

“…These findings support themes in the qualitative study by Boss et al 18 in which parents commented on the importance of longitudinal, supportive relationships and communication with their pediatricians. Further, it has been suggested that the decision for surgery may be made in collaboration with their PCP, with whom they interact more frequently, even before discussions with the otolaryngologist 26 . PCPs have been described as gatekeepers of health care systems and therefore education in the primary care arena may improve equitable access to specialty care in SDB.…”

“…Further, it has been suggested that the decision for surgery may be made in collaboration with their PCP, with whom they interact more frequently, even before discussions with the otolaryngologist. 26 PCPs have been described as gatekeepers of health care systems and therefore education in the primary care arena may improve equitable access to specialty care in SDB.…”

Use of Polysomnography and CPAP in Children Who Received Adenotonsillectomy, US 2004 to 2018

“…This may be because parents with higher medical literacy are more receptive of medical interventions. 33 Given the low use of pediatric PSG nationally and the socioeconomic differences in use of sleep health care, we advocate for increased access to comprehensive, multidisciplinary diagnostics and treatment for pediatric OSAS. The responsibility for screening should be shared by all providers involved in the continuum of OSA care: primary care pediatricians, pulmonary and sleep specialists, otolaryngologists, dentists, and neurologists.…”

“…We found that children from higher education households were more likely to be evaluated for persistent sleep symptoms after TA and treated with CPAP. This may be because parents with higher medical literacy are more receptive of medical interventions 33 . Additionally, families with other members having previously undergone repeat PSG or using CPAP may be more willing to pursue postoperative interventions.…”