Inpatient Versus Outpatient Management of Low-Risk Pediatric Febrile Neutropenia: Measuring Parents' and Healthcare Professionals' Preferences

Abstract

A B S T R A C T PurposeOur primary objective was to describe and compare parents' and healthcare professionals' strength of preference scores for outpatient oral antibiotic relative to inpatient parenteral antibiotic treatment for low-risk febrile neutropenic children. Our secondary objective was to identify predictors of strength of preference for oral outpatient treatment. MethodsRespondents were parents of children receiving cancer chemotherapy, and pediatric oncology healthcare professionals. First, the inpatient and outpatient options were described, and the respondent indicated their initially preferred option. The respondent next ranked how important seven factors (including "fear/anxiety" and "comfort") were in making their initial choice. The threshold technique was then used to elicit the respondent's strength of preference score for oral outpatient, relative to parenteral inpatient management. ResultsThere were 75 parent and 42 healthcare-professional respondents. There was no significant difference (P ϭ .08) in the proportions of parents (40 of 75; 53%) and healthcare professionals (30 of 42; 71%) who initially would choose outpatient management. For parents, stronger preference for oral outpatient therapy was associated with higher anticipated quality of life for the parent and child at home relative to hospital, lower importance rank for "fear/anxiety," and higher importance rank for "comfort." Conversely, for professionals, only lower importance rank for "fear/anxiety" was associated with higher strength of preference scores for outpatient oral antibiotic management. ConclusionOnly 53% of parents would choose outpatient oral antibiotic management for low-risk febrile neutropenia. Predictors of strength of preference scores for outpatient oral antibiotic relative to inpatient parenteral antibiotic treatment differed between parent and professional respondents.

Clinical practice patterns of managing low-risk adult febrile neutropenia during cancer chemotherapy in the USA

“…This finding is in keeping with current practice guidelines that advocate judicious use of outpatient management strategies for low-risk febrile neutropenic patients [11,17]. Surveys of practice in France and Canada have similarly indicated that at least two thirds of clinicians utilize outpatient management for patients with fever and short durations of neutropenia [4,37]. In contrast, a recent survey from the UK found that only two in five clinicians stratify patients to "low risk" in the management of febrile neutropenia, but they use inconsistent risk criteria to identify this group [18].…”

First‐day step‐down to oral outpatient treatment versus continued standard treatment in children with cancer and low‐risk fever in neutropenia. A randomized controlled trial within the multicenter SPOG 2003 FN study

“…The unexpectedly high proportion of patients and parents declining consent to randomization because they preferred inpatient therapy [40][41][42] was one of several factors leading to low accrual. Too frequent outpatient visits and fear that the experimental treatment might be less secure than standard treatment have been quoted by parents and patients.…”

Outpatient and oral antibiotic management of low-risk febrile neutropenia are effective in children—a systematic review of prospective trials

“…Centers should therefore adopt these lower-intensity strategies for low-risk pediatric FN patients if the infrastructure to safely manage outpatients can be established. While useful for clinical decisionmaking, the results of this study may also assist in educating and reassuring patients and families who might otherwise prefer inpatient management of FN [43]. Future research should focus on knowledge translation and effectiveness analysis of large numbers of patients treated outside of research protocols as more centers begin to adopt these lower-intensity strategies for low-risk pediatric FN.…”