Shared decision-making in pediatric otolaryngology: Parent, physician and observational perspectives

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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.

Section: Discussionsupporting

confidence: 70%

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

Graham

Westerberg

Lea

et al. 2018

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“…In a pilot study looking at shared decision-making in pediatric otolaryngology, parents’ perceptions of shared decision-making were negatively correlated with decisional conflict [11]. However, analysis of videotaped data (e.g., amount of talking done by parent, number of questions asked) did not correlate with perceptions of shared decision-making, suggesting there may be a discrepancy in how parents’ perceive their involvement versus their actual engagement during the surgical consultation [23]. Overall, the conclusion was that many parents experienced decisional conflict and strategies to increase shared-decision making (e.g., via decision support tools) are needed for parents considering elective pediatric otolaryngology surgeries.…”

Section: Resultsmentioning

confidence: 99%

Decision aid prototype development for parents considering adenotonsillectomy for their children with sleep disordered breathing

Maguire

Hong

Ritchie

et al. 2016

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BackgroundTo describe the process involved in developing a decision aid prototype for parents considering adenotonsillectomy for their children with sleep disordered breathing.MethodsA paper-based decision aid prototype was developed using the framework proposed by the International Patient Decision Aids Standards Collaborative. The decision aid focused on two main treatment options: watchful waiting and adenotonsillectomy. Usability was assessed with parents of pediatric patients and providers with qualitative content analysis of semi-structured interviews, which included open-ended user feedback.ResultsA steering committee composed of key stakeholders was assembled. A needs assessment was then performed, which confirmed the need for a decision support tool. A decision aid prototype was developed and modified based on semi-structured qualitative interviews and a scoping literature review. The prototype provided information on the condition, risk and benefits of treatments, and values clarification. The prototype underwent three cycles of accessibility, feasibility, and comprehensibility testing, incorporating feedback from all stakeholders to develop the final decision aid prototype.ConclusionA standardized, iterative methodology was used to develop a decision aid prototype for parents considering adenotonsillectomy for their children with sleep disordered breathing. The decision aid prototype appeared feasible, acceptable and comprehensible, and may serve as an effective means of improving shared decision-making.

“…The current results are based on descriptive coding of the video-recordings of surgical consultations using the OPTION scale (see below for details). Previous research conducted by our group used a different coding system (Roter Interaction Analysis System) to quantify interactions between providers and patients/families during medical encounters [15].…”

Section: Methodsmentioning

confidence: 99%

Perceptions and observations of shared decision making during pediatric otolaryngology surgical consultations

Evong

Chorney

Ungar

et al. 2019

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Objective Increased parental involvement in the decision-making process when considering elective surgeries for their children, termed shared decision-making (SDM), may lead to positive outcomes. The objective of this study was to describe perceived and observed levels of SDM during pediatric otolaryngology consultations. Methods One hundred and seventeen parents and their children undergoing elective surgical consultations were prospectively enrolled. The visits were videotaped and coded using the Observing Patient Involvement (OPTION) scale. Following the encounter, all participants completed a questionnaire that measured perceived levels of SDM (SDM-Q-9). Surgeons also completed a similar questionnaire (SDM-Q-Doc). Spearman’s correlation coefficient was determined to measure the associations between observed and perceived levels of SDM. Results The overall OPTION scores were low (median score of 14 out of 48) and not significantly correlated with perceived levels of SDM (SDM-Q-9, p = 0.415; SDM-Q-Doc, p = 0.236), surgery type ( p = 0.197), or patient demographic factors. The OPTION scores were positively correlated with consultation length ( p < 0.001). There was great variability in the level to which each OPTION items were observed during the consultation (not present in any visits to present in 96.6% of the visits). Conclusions Observed levels of SDM were consistently low, but higher levels were observed when the surgeon spent more time during the consultation. Observed levels of SDM did not match perceived levels of SDM, which were consistently rated higher by both caregivers and surgeons.