Abstract
BackgroundLittle data exists regarding decision-making preferences for parents and surgeons in pediatric surgery. Here we investigate whether parents and surgeons have similar decision-making preferences as well as which factors influence those preferences. Specifically, we compare parents’ and surgeons’ assessments of the urgency and complexity of pediatric surgical scenarios and the impact of their assessments on decision-making preferences.MethodsA survey was emailed to parents of patients evaluated in a university-based pediatric surgery clinic and surgeons belonging to the American Pediatric Surgical Association. The survey asked respondents to rate 6 clinical vignettes for urgency, complexity, and desired level of surgeon guidance using the Controlled Preferences Scale (CPS).ResultsRegarding urgency, parents were more likely than surgeons to rate scenarios as emergent when cancer was involved (parents: 68.8% cancer vs. 29.5% non-cancer, p < .001; surgeons: 19.2% cancer vs. 25.4% non-cancer, p = .051). Parents and surgeons were more likely to rate a scenario as emergent when a baby was involved (parents: 45.2% baby vs. 36.2% child, p = .001; surgeons: 28.0% baby vs. 14.0% child, p < .001). Regarding decision-making preferences, parents and surgeons had similar CPS scores (2.56 vs. 2.72, respectively). Multivariable analysis showed parents preferred more surgeon guidance when scenarios involved a baby (OR 1.22; 95% CI 1.08–1.37; p < 0.01) or a cancer diagnosis (OR 1.29; 95% CI 1.11–1.49; p < 0.01), and that both parents and surgeons preferred more surgeon guidance when a scenario was considered emergent (parents: OR 1.81; 95% CI 1.37–2.38, p < 0.001; surgeons: OR 2.48 95% CI 1.76–3.49, p < 0.001).ConclusionsWhen a pediatric patient is a baby or has cancer, parents are more likely then surgeons to perceive the clinical situation to be emergent, and both parents and surgeons prefer more surgeon guidance in decision-making when a clinical scenario is considered emergent. More research is needed to understand how parents’ decision-making preferences depend on clinical context.
Highlights
Little data exists regarding decision-making preferences for parents and surgeons in pediatric surgery
Difficulty lies in the direct application of Shared decision-making (SDM) models, which have typically been created for adult patients, to pediatric care where the decision maker is not a competent, adult patient but rather a surrogate decision maker who is tasked with making decisions in the best interest of the child [11, 14]
It contrasts with surrogate decision makers for adult patients who do not have decision-making capacity in that such surrogates are tasked with applying substituted judgement as opposed to best interest standards [14]
Summary
Little data exists regarding decision-making preferences for parents and surgeons in pediatric surgery. Difficulty lies in the direct application of SDM models, which have typically been created for adult patients, to pediatric care where the decision maker is not a competent, adult patient but rather a surrogate decision maker (i.e. parent or legal guardian) who is tasked with making decisions in the best interest of the child [11, 14] This contrasts with adult patients who are encouraged to make decisions consistent with their own values and priorities. It contrasts with surrogate decision makers for adult patients who do not have decision-making capacity in that such surrogates are tasked with applying substituted judgement (i.e. what the patient would prefer if he or she were able to decide) as opposed to best interest standards [14] These differences create challenges with direct application of SDM to pediatrics and have limited investigation of the efficacy of SDM in pediatrics [14, 15]
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