Abstract
BackgroundThe risks and benefits of infection prophylaxis are uncertain in children with cancer and thus, preferences should be considered in decision making. The purpose of this report was to describe the attitudes of parents, children and healthcare professionals to infection prophylaxis in pediatric oncology.MethodsThe study was completed in three phases: 1) An initial qualitative pilot to identify the main attributes influencing the decision to use infection prophylaxis, which were then incorporated into a discrete choice experiment; 2) A think aloud during the discrete choice experiment in which preferences for infection prophylaxis were elicited quantitatively; and 3) In-depth follow up interviews. Interviews were recorded verbatim and analyzed using an iterative, thematic analysis. Final themes were selected using a consensus approach.ResultsA total of 35 parents, 22 children and 28 healthcare professionals participated. All three groups suggested that the most important factor influencing their decision making was the effect of prophylaxis on reducing the chance of death. Themes of importance to the three groups included antimicrobial resistance, side effects of medications, the financial impact of outpatient prophylaxis and the route and schedule of administration.ConclusionEffect of prophylaxis on risk of death was a key factor in decision making. Other identified factors were antimicrobial resistance, side effects of medication, financial impact and administration details. Better understanding of factors driving decision making for infection prophylaxis will help facilitate future implementation of prophylactic regiments.
Highlights
Infections in pediatric oncology patients are associated with morbidity and mortality. [1] Antimicrobial agents can be used to treat documented infections, as empiric therapy for suspected infections, or as prophylaxis to prevent infections
[7] Little is known about the attitudes of parents, children or healthcare professionals (HCPs) toward infection prophylaxis in pediatric oncology
Twenty-six parents, 19 children and 21 HCPs participated in the think aloud’’ (TAL)
Summary
Infections in pediatric oncology patients are associated with morbidity and mortality. [1] Antimicrobial agents can be used to treat documented infections, as empiric therapy for suspected infections, or as prophylaxis to prevent infections. [3,4] even among adult patients, there are questions about the consequences of prophylaxis and the impact on antimicrobial resistance is uncertain. [5,6] Further, the consequences of infection prophylaxis in young children are uncertain. Because of the uncertainty about the balance of risks and benefits of infection prophylaxis, preferences should be considered in the decision-making process. [7] Little is known about the attitudes of parents, children or healthcare professionals (HCPs) toward infection prophylaxis in pediatric oncology. The risks and benefits of infection prophylaxis are uncertain in children with cancer and preferences should be considered in decision making. The purpose of this report was to describe the attitudes of parents, children and healthcare professionals to infection prophylaxis in pediatric oncology
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