Informed Consent in Pediatric Otolaryngology

Pianosi, Kiersten; Gorodzinsky, Ayala Y.; Chorney, Jill; Corsten, Gerard; Johnson, Liane B.; Hong, Paul

doi:10.1177/0194599816641910

Cited by 23 publications

(8 citation statements)

References 23 publications

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“…This was a novel finding that could not be determined in our previous study due to the smaller sample size. 10 Hence, although physicians have varied interaction styles and even dispense different content and amount of information when discussing the same surgical procedure, 24 it did not significantly impact parents' level of decisional conflict. The implication may be that health care provider influences, at least in this relatively homogeneous sample of providers, are not as imperative as parents' perceptions of shared decision making when considering decisional conflict as a measure of decision quality.…”

Section: Discussionmentioning

confidence: 99%

Decision-Making Quality in Parents Considering Adenotonsillectomy or Tympanostomy Tube Insertion for Their Children

Hong

Maguire

Purcell

et al. 2017

JAMA Otolaryngol Head Neck Surg

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Many parents experienced significant decisional conflict when making decisions about their child's elective surgical treatment. Parents who perceived themselves as being more involved in the decision-making process reported less decisional conflict and decisional regret. Future research should explore the influence of decision quality on health outcomes and develop methods to improve shared decision making.

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Section: Discussionmentioning

confidence: 99%

Decision-Making Quality in Parents Considering Adenotonsillectomy or Tympanostomy Tube Insertion for Their Children

Hong

Maguire

Purcell

et al. 2017

JAMA Otolaryngol Head Neck Surg

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“…We found that parents correctly answered 80% of knowledge scale items on the postconsult survey following clinician discussion of the relevant item. As the knowledge measure was completed immediately postconsultation, it is not surprising that this accuracy is higher than recall rates reported in previous studies when patients were asked to recall surgical risks and benefits weeks after surgical consultations 13‐17 . However, this finding suggests that pediatric surgical consent might be optimally attained shortly following a comprehensive discussion of the risks and benefits, when parents or other decision‐makers may retain most of the information that was discussed.…”

Section: Discussionmentioning

confidence: 80%

“…As the knowledge measure was completed immediately postconsultation, it is not surprising that this accuracy is higher than recall rates reported in previous studies when patients were asked to recall surgical risks and benefits weeks after surgical consultations. [13][14][15][16][17] However, this finding suggests that pediatric surgical consent might be optimally attained shortly following a comprehensive discussion of the risks and benefits, when parents or other decision-makers may retain most of the information that was discussed. Because parents in our study incorrectly answered 20% of knowledge scale items that had been directly addressed during the consultation, multimodal briefs such as informational handouts, pictures, and videos may be useful to clarify misunderstandings during the conversation and support parents' recall over time.…”

Section: Discussionmentioning

confidence: 99%

Surgeon Information‐Sharing, Parent Verbal Engagement, and Parent Knowledge of Pediatric Adenotonsillectomy

Claus,

Amos,

Links

et al. 2023

Otolaryngol.--head neck surg.

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ObjectiveWe characterize clinician information‐sharing and parent verbal engagement during pediatric adenotonsillectomy consultations and evaluate whether these behaviors relate to disease‐specific knowledge for parents of children with obstructive sleep‐disordered breathing (OSDB).Study DesignMixed‐methods sequential explanatory analysis.SettingOutpatient otolaryngology clinics.MethodsWe analyzed audio‐recorded communication during outpatient encounters for children undergoing initial evaluation for adenotonsillectomy. We identified discrete triadic instances of clinician discussion of individual risks and benefits, parent verbal responses coded as passive (“Right”) or active (“Would that repeat the recovery time?”), and corresponding parent answer (correct or incorrect) on a postconsult knowledge questionnaire. Primary outcomes included parent knowledge and decisional conflict. We qualitatively analyzed substantive questions asked by parents during the encounter.ResultsIn 30 consults, clinicians (n = 8) provided 156 instances of discussion (101 risk, 55 benefit), to which parents provided 34% active responses. Clinician discussion of risks and benefits was associated with greater parent knowledge (odds ratio [OR] = 3.70, 95% confidence interval [CI]: 2.25‐6.09; P < .001), however parent active engagement was not associated with greater parent knowledge (OR = 1.04, 95% CI: 0.42‐2.58, P = .93). Parents demonstrated greater knowledge of benefits than risks (χ2 = 23.16, V = 1.13; P < .001). Parents who responded actively (OR = 0.26, 95% CI: 0.09‐0.72; P = .010) or had greater knowledge (OR = 0.41, 95% CI: 0.21‐0.81; P = .010) had less decisional conflict.ConclusionClinician information‐sharing was associated with greater parent knowledge about OSDB treatment. Greater parent engagement and knowledge were independently associated with less decisional conflict. These findings may inform clinicians' approaches to counseling and engaging parents in decisions for surgery.

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“…Other research that evaluates parent-centered outcomes in pediatric tonsillectomy focus on outcomes such as disease-specific and health-related quality of life, parental knowledge about otolaryngologic disease and surgical procedures, parental satisfaction with care, and parental surgical decision conflict . Our study complements these previous studies by looking at parental experiences outside of the clinical context.…”

Section: Discussionmentioning

confidence: 85%

Evaluation of Parental Perspectives and Concerns About Pediatric Tonsillectomy in Social Media

Hairston

Links

Harris

et al. 2019

JAMA Otolaryngol Head Neck Surg

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Importance: Tonsillectomy is common in children, but little is known about parental preferences and values concerning this surgery. Social media offers a novel opportunity to evaluate parent understanding and experience of care. Objective: We systematically evaluate posts in a well-known social media site to identify parent perspectives about tonsillectomy in children that may not be apparent in a routine clinical encounter. Design: In this mixed methods analysis, we searched Twitter© for posts (“tweets”) from 2008-2017 written by parents about their child’s tonsillectomy. We applied modified grounded theory to develop a coding taxonomy to classify these tweets. Two reviewers assessed tweets for thematic synthesis and classification. Tweets were quantified, and descriptive statistics were obtained for each theme. Setting: The posts on the social media site www.twitter.com. Participants: A sample of over 700 adult American parents of children who received or will receive a tonsillectomy and posted on Twitter. Main Outcomes and Measures: Themes of parent experiences and perspectives about their child’s tonsillectomy. Results: Of 5801 tweets retrieved, 782 satisfied our inclusion criteria. Tweets fell into overarching themes of 1. procedural concerns (n=549, 70.2%) and 2. attitudes/experiences (n=498, 63.7%). Common tweets related to procedural concerns regarded surgical indication (“sick for months”; n=55,7.0%), recovery [n=227, 29.0%; including child’s attitude (“she is nervous”; n=89, 11.4%) nutrition (“won’t eat”; n=89, 11.4%), and parental experience (“harder on the parents than the kid”;(n=87, 11.1%))]. Common tweets regarding attitudes/experiences included tenor of overall care (“yay for tonsil surgery!”; n=155, 19.8%), and fears/apprehensions (“frankly, I’m terrified”; n=178, 22.8%). Conclusions and Relevance: This analysis provides insight into parent perspectives on pediatric tonsillectomy. Parents commonly tweet concerns about surgery that may not be recognized in routine clinician-parent dialogue. Findings may be used to guide clinicians in educating and counseling parents, and further engaging parents and children in shared decision-making for tonsillectomy.

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Informed Consent in Pediatric Otolaryngology

Cited by 23 publications

References 23 publications

Decision-Making Quality in Parents Considering Adenotonsillectomy or Tympanostomy Tube Insertion for Their Children

Decision-Making Quality in Parents Considering Adenotonsillectomy or Tympanostomy Tube Insertion for Their Children

Surgeon Information‐Sharing, Parent Verbal Engagement, and Parent Knowledge of Pediatric Adenotonsillectomy

Evaluation of Parental Perspectives and Concerns About Pediatric Tonsillectomy in Social Media

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