Parental decision making in pediatric otoplasty: The role of shared decision making in parental decisional conflict and decisional regret

Hong, Paul; Gorodzinsky, Ayala Y.; Taylor, Benjamin A.; Chorney, Jill

doi:10.1002/lary.26071

Cited by 53 publications

(81 citation statements)

References 46 publications

(99 reference statements)

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“…In the current study, 33.3% of parents had clinically significant decisional conflict. This is consistent with other studies assessing elective pediatric surgeries . Because tonsillectomy is one of the most commonly performed procedures in children in North America, the number of parents with significant uncertainty could be substantial.…”

Section: Discussionsupporting

confidence: 88%

Decision aid prototype for treatment of pediatric sleep disordered breathing: A randomized pilot study

2018

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Objectives 1) To examine the feasibility and usability of a decision aid prototype (DA) for pediatric obstructive sleep apnea (OSA). 2) to estimate parameters for a future randomized controlled trial. Study Design Multicenter randomized pilot trial. Methods Ninety‐nine parents of children ( < 6 years of age) undergoing consultation for adenotonsillectomy for sleep‐disordered breathing were prospectively enrolled. Families were randomly assigned to receive the DA or to follow standard care procedures. All consultations were video‐recorded and coded with the observing patient involvement in decision making (OPTION) instrument. Following the consultation, parents completed the Decisional Conflict Scale (DCS) and Shared Decision‐Making Questionnaire (SDM‐Q‐9), whereas otolaryngologists completed the physician version (SDM‐Q‐Doc). A subset of parents and surgeons were interviewed to assess the usability of the DA. Results: Overall, a significantly negative correlation between DCS and SDM‐Q‐9 was observed (P < 0.001). Interviews showed that parents found the DA helpful but wanted more time to read and contemplate the information. Both parents and surgeons indicated that instructions on how to use the DA would be beneficial. For parents receiving the DA, the mean total OPTION score was 13.83 out of 40 (standard deviation 5.24), compared to 11.95 (standard deviation 5.21) in those not receiving the DA (P = 0.11). There were no significant differences in the decisional conflict or shared decision making when using the DA. Conclusion: The DA was feasible but used differently among surgeons. The need to improve SDM techniques was suggested by both surgeons and parents. Future studies training otolaryngologists on effective SDM techniques and how to appropriately utilize decision aids may improve SDM for pediatric OSA. Level of Evidence 1b Laryngoscope, 129:229–234, 2019

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Section: Discussionsupporting

confidence: 88%

Decision aid prototype for treatment of pediatric sleep disordered breathing: A randomized pilot study

2018

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“…This has also been shown in pediatric urology, with nearly a third of parents considering hypospadias repair for their child experiencing decisional conflict [16]. The proportion of patients with significant decisional conflict in the current study compares with data on pediatric patients undergoing elective procedures [15] but is less than adult patients considering thyroidectomy for indeterminate nodules, (34%) [17], or pediatric patients considering bone anchored hearing aids (43.5%) [18] or otoplasty (32.8%) [25]. The degree of conflict experienced by patients appears to vary considerably depending on the condition and ramifications of surgery.…”

Section: Discussionmentioning

confidence: 93%

“…In future studies, it would be useful to follow these patients longitudinally, to determine if decisional conflict is related to the degree of decisional regret associated with decisions patients make, as seen in some previous studies [16, 22, 25]. …”

Section: Discussionmentioning

confidence: 99%

Shared decision making and decisional conflict in the Management of Vestibular Schwannoma: A prospective cohort study

Graham

Westerberg

Lea

et al. 2018

Journal of Otolaryngology - Head & Neck Surgery

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BackgroundPatients with vestibular schwannomas (VS) are faced with complex management decisions. Watchful waiting, surgical resection, and radiation are all viable options with associated risks and benefits. We sought to determine if patients with VS experience decisional conflict when deciding between surgery or non-surgical management, and factors influencing the degree of decisional conflict.MethodsA prospective cohort study in two tertiary ambulatory skull-base clinics was performed. Patients with newly diagnosed or newly growing vestibular schwannomas were recruited. Patients were given a demographic form and the decisional conflict scale (DCS), a validated measure to assess the degree of uncertainty when making medical decisions. The degree of shared decision making (SDM) experienced by the patient and physician were assessed via the SDM-Q-10 and SDM-Q-Doc questionnaires, respectively. Non-parametric statistics were used. Questionnaires and demographic information were correlated with DCS using Spearman correlation coefficient and Mann-Whitney U. Logistic regression was performed to determine factors independently associated with DCS scores.ResultsSeventy-seven patients participated (55% female, aged 37–81 years); VS ranged in size from 2 mm–50 mm. Significant decisional conflict (DCS score 25 or greater) was experienced by 17 (22%) patients. Patients reported an average SDM-Q-10 score of 86, indicating highly perceived level of SDM. Physician and patient SDM scores were weakly correlated (p = 0.045, Spearman correlation coefficient 0.234). DCS scores were significantly negatively correlated with a decision to pursue surgery, presence of a trainee, and higher SDM-Q-10 score. DCS was higher with female gender. Using logistic regression, the SDM-Q-10 score was the only variable associated with significantly reduced DCS.ConclusionsAbout one fifth of patients deciding how to manage their vestibular schwannoma experienced a significant degree of decisional conflict. Involving the patients in the process through shared decision-making significantly reduced the degree of uncertainty patients experienced.

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“…For example, 6% of women considering prenatal screening for Down syndrome experienced decisional conflict [25]. In contrast, 28% of parents considering hypospadias repair for their son and 33% of parents considering otoplasty experienced decisional conflict [26, 27]. Consideration of context is important in order to better understand parents’ experience of the decision making process and decisional conflict [22].…”

Section: Introductionmentioning

confidence: 99%

Parental decision making involvement and decisional conflict: a descriptive study

et al. 2017

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BackgroundDecisional conflict is a state of uncertainty about the best treatment option among competing alternatives and is common among adult patients who are inadequately involved in the health decision making process. In pediatrics, research shows that many parents are insufficiently involved in decisions about their child’s health. However, little is known about parents’ experience of decisional conflict. We explored parents’ perceived decision making involvement and its association with parents’ decisional conflict.MethodWe conducted a descriptive survey study in a pediatric tertiary care hospital. Our survey was guided by validated decisional conflict screening items (i.e., the SURE test). We administered the survey to eligible parents after an ambulatory care or emergency department consultation for their child.ResultsFour hundred twenty-nine respondents were included in the analysis. Forty-eight percent of parents reported not being offered treatment options and 23% screened positive for decisional conflict. Parents who reported being offered options experienced less decisional conflict than parents who reported not being offered options (5% vs. 42%, p < 0.001). Further, parents with options were more likely to: feel sure about the decision (RR 1.08, 95% CI 1.02–1.15); understand the information (RR 1.92, 95% CI 1.63–2.28); be clear about the risks and benefits (RR 1.12, 95% CI 1.05–1.20); and, have sufficient support and advice to make a choice (RR 1.07, 95% CI 1.03–1.11).ConclusionMany parents in our sample experienced decisional conflict after their clinical consultation. Involving parents in the decision making process might reduce their risk of decisional conflict. Evidence based interventions that support parent decision making involvement, such as shared decision making, should be evaluated and implemented in pediatrics as a strategy to reduce parents’ decisional conflict.Electronic supplementary materialThe online version of this article (doi:10.1186/s12887-017-0899-4) contains supplementary material, which is available to authorized users.

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Parental decision making in pediatric otoplasty: The role of shared decision making in parental decisional conflict and decisional regret

Abstract: 2b. Laryngoscope, 126:S5-S13, 2016.

Cited by 53 publications

References 46 publications

Decision aid prototype for treatment of pediatric sleep disordered breathing: A randomized pilot study

Decision aid prototype for treatment of pediatric sleep disordered breathing: A randomized pilot study

Shared decision making and decisional conflict in the Management of Vestibular Schwannoma: A prospective cohort study

Parental decision making involvement and decisional conflict: a descriptive study

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