Cross-Sectional Evaluation of Parental Decision Making Factors for Vesicoureteral Reflux Management in Children

Hsieh, Michael H.; Madden‐Fuentes, Ramiro J.; Bayne, Aaron; Munch, Erika; Wildenfels, Patience; Alexander, Sandra J.; Gonzales, Edmond T.; Cisek, Lars J.; Jones, Eric A.; Roth, David R.

doi:10.1016/j.juro.2010.03.083

Cited by 21 publications

(13 citation statements)

References 10 publications

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“…29 Similarly, in a recent survey of parents making decisions about treatment for children with vesicoureteral reflux, more than 90% considered the urologist’s opinion to be very or extremely important. 51 …”

Section: Resultsmentioning

confidence: 99%

What Is Known about Parents’ Treatment Decisions? A Narrative Review of Pediatric Decision Making

Lipstein¹,

Brinkman

Britto³

2011

Med Decis Making

192

180

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Background With the increasing complexity of decisions in pediatric medicine, there is a growing need to understand the pediatric decision-making process. Objective To conduct a narrative review of the current research on parent decision making about pediatric treatments and identify areas in need of further investigation. Methods Articles presenting original research on parent decision making were identified from MEDLINE (1966–6/2011), using the terms “decision making,” “parent,” and “child.” We included papers focused on treatment decisions but excluded those focused on information disclosure to children, vaccination, and research participation decisions. Results We found 55 papers describing 52 distinct studies, the majority being descriptive, qualitative studies of the decision-making process, with very limited assessment of decision outcomes. Although parents’ preferences for degree of participation in pediatric decision making vary, most are interested in sharing the decision with the provider. In addition to the provider, parents are influenced in their decision making by changes in their child’s health status, other community members, prior knowledge, and personal factors, such as emotions and faith. Parents struggle to balance these influences as well as to know when to include their child in decision making. Conclusions Current research demonstrates a diversity of influences on parent decision making and parent decision preferences; however, little is known about decision outcomes or interventions to improve outcomes. Further investigation, using prospective methods, is needed in order to understand how to support parents through the difficult treatment decisions.

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Section: Resultsmentioning

confidence: 99%

What Is Known about Parents’ Treatment Decisions? A Narrative Review of Pediatric Decision Making

Lipstein¹,

Brinkman

Britto³

2011

Med Decis Making

192

180

View full text Add to dashboard Cite

show abstract

“…A recent study on the treatment patterns of reflux showed that 80% of parents of patients with moderately severe VUR chose endoscopic injection when given information on each of the treatment options [57]. Both the opinion of the pediatric urologist and the individual hospital at which the patient seeks treatment influenced the procedure performed [58, 59]. …”

Section: Discussionmentioning

confidence: 99%

Surgical management of vesicoureteral reflux in children

Sung

Skoog

2011

Pediatr Nephrol

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Vesicoureteral reflux (VUR) is the most common uropathy affecting children. Compared to children without VUR, those with VUR have a higher rate of pyelonephritis and renal scarring following urinary tract infection (UTI). Options for treatment include observation with or without antibiotic prophylaxis and surgical repair. Surgical intervention may be necessary in patients with persistent reflux, renal scarring, and recurrent or breakthrough febrile UTI. Both open and endoscopic approaches to reflux correction are successful and reduce the occurrence of febrile UTI. Estimated success rates of open and endoscopic reflux correction are 98.1% (95% CI 95.1, 99.1) and 83.0% (95% CI 69.1, 91.4), respectively. Factors that affect the success of endoscopic injection include pre-operative reflux grade and presence of functional or anatomic bladder abnormalities including voiding dysfunction and duplicated collecting systems. Few studies have evaluated the long-term outcomes of endoscopic injection, and with variable results. In patients treated endoscopically, recurrent febrile UTI occurred in 0–21%, new renal damage in 9–12%, and recurrent reflux in 17–47.6% of treated ureters with at least 1 year follow-up. These studies highlight the need for standardized outcome reporting and longer follow-up after endoscopic treatment.

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“…Education and counseling play an important role in parental preferences of VUR management, with the pediatric urologist's opinion often cited as the chief determining factor. 28,29 VURx is applicable only to children diagnosed with primary VUR before 2 years of age.…”

Section: A N U S C R I P Tmentioning

confidence: 99%