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Mullan PC, Levasseur KA, Bajaj L, Nypaver M, Chamberlain JM, Thull-Freedman J, Ostrow O, Jain S. Recommendations for Choosing Wisely in Pediatric Emergency Medicine: Five Opportunities to Improve Value. Ann Emerg Med 2024; 84:167-175. [PMID: 38349290 DOI: 10.1016/j.annemergmed.2024.01.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2023] [Revised: 12/15/2023] [Accepted: 01/04/2024] [Indexed: 07/22/2024]
Abstract
Unnecessary diagnostic tests and treatments in children cared for in emergency departments (EDs) do not benefit patients, increase costs, and may result in harm. To address this low-value care, a taskforce of pediatric emergency medicine (PEM) physicians was formed to create the first PEM Choosing Wisely recommendations. Using a systematic, iterative process, the taskforce collected suggested items from an interprofessional group of 33 ED clinicians from 6 academic pediatric EDs. An initial review of 219 suggested items yielded 72 unique items. Taskforce members independently scored each item for its extent of overuse, strength of evidence, and potential for harm. The 25 highest-rated items were sent in an electronic survey to all 89 members of the American Academy of Pediatrics PEM Committee on Quality Transformation (AAP COQT) to select their top ten recommendations. The AAP COQT survey had a 63% response rate. The five most selected items were circulated to over 100 stakeholder and specialty groups (within the AAP, CW Canada, and CW USA organizations) for review, iterative feedback, and approval. The final 5 items were simultaneously published by Choosing Wisely United States and Choosing Wisely Canada on December 1, 2022. All recommendations focused on decreasing diagnostic testing related to respiratory conditions, medical clearance for psychiatric conditions, seizures, constipation, and viral respiratory tract infections. A multinational PEM taskforce developed the first Choosing Wisely recommendation list for pediatric patients in the ED setting. Future activities will include dissemination efforts and interventions to improve the quality and value of care specific to recommendations.
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Affiliation(s)
- Paul C Mullan
- Division of Emergency Medicine, Department of Pediatrics, Eastern Virginia Medical School, Children's Hospital of the King's Daughters, Norfolk, VA.
| | - Kelly A Levasseur
- Division of Pediatrics, Central Michigan University, Children's Hospital of Michigan, Detroit, MI
| | - Lalit Bajaj
- Department of Pediatrics and Emergency Medicine, University of Colorado School of Medicine, Children's Hospital Colorado, Aurora, CO
| | - Michele Nypaver
- Departments of Emergency Medicine and Pediatrics, University of Michigan Medical School, and Michigan Emergency Department Improvement Collaborative (funded by BCBSM), Ann Arbor, MI
| | - James M Chamberlain
- Division of Emergency Medicine, Pediatrics and Emergency Medicine, George Washington University, Children's National Hospital, Washington, DC
| | - Jennifer Thull-Freedman
- Departments of Pediatrics and Emergency Medicine, University of Calgary, Alberta Children's Hospital, Calgary, AB, Canada
| | - Olivia Ostrow
- Division of Emergency Medicine, University of Toronto, the Hospital for Sick Children, Toronto, ON, Canada
| | - Shabnam Jain
- Pediatrics and Emergency Medicine, Emory University, Children's Healthcare of Atlanta, Atlanta, GA
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Kroshus-Havril E, Opel DJ, Jinguji TM, Steiner MK, Senturia K, MacDonald JP, Master CL, Giza CC, Burton MS, Quitiquit C, Krabak BJ, Kotch JP, Rivara FP. Shared Decision-Making About Returning to Sport After Recovery From Pediatric Concussion: Clinician Perspectives. Clin J Sport Med 2024:00042752-990000000-00217. [PMID: 39037366 DOI: 10.1097/jsm.0000000000001244] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2023] [Accepted: 05/31/2024] [Indexed: 07/23/2024]
Abstract
OBJECTIVE Describe how sports medicine clinicians support decision making about sport participation after concussion recovery with adolescent patients and their parents. Specific areas of inquiry related to how clinicians framed the decision, what factors they considered in how they approached the decision process, and how they navigated discordance within families. DESIGN Qualitative study. SETTING Tertiary care sports medicine clinics at 4 children's hospitals in the United States. PARTICIPANTS Individual interviews were conducted with 17 clinicians practicing in sports medicine settings. INTERVENTIONS N/A. MAIN OUTCOME MEASURES Semi-structured interviews explored clinician approaches to supporting decision making, with the question guide informed by components of the Ottawa Decision Support Framework. RESULTS Clinicians routinely incorporated aspects of shared decision making (SDM) into their conversations with families. This included ensuring all parties were informed about risk and aligned behind a shared value of adolescent well-being. Mediation strategies were used to manage discordance between adolescents and their parents, and between parents. These strategies aimed to facilitate a decision that was adolescent centered. When clinicians believed that there was a medical benefit to modifying the adolescent's sport participation practices, or when they did not believe the athlete was psychologically ready to return to the sport in which they were injured, they initiated conversations about alternative activities. In such situations, they used persuasive communication practices to encourage families to strongly consider this option. CONCLUSION The strengths and strategies used by sports medicine clinicians in this study provide a foundation for guidance or intervention development aimed at supporting SDM after concussion with adolescents and their families.
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Affiliation(s)
- Emily Kroshus-Havril
- University of Washington School of Medicine, Department of Pediatrics, Seattle, WA
- Seattle Children's Research Institute, Center for Child Health, Behavior and Development, Seattle, WA
| | - Douglas J Opel
- University of Washington School of Medicine, Department of Pediatrics, Seattle, WA
- Seattle Children's Research Institute, Center for Clinical and Translational Research, Seattle, WA
| | - Thomas M Jinguji
- University of Washington School of Medicine, Department of Pediatrics, Seattle, WA
- Seattle Children's Research Institute, Center for Clinical and Translational Research, Seattle, WA
- University of Washington School of Medicine, Department of Orthopedics and Sports Medicine, Seattle, WA
- Seattle Children's Hospital, Orthopedics and Sports Medicine, Seattle, WA
| | - Mary Kathleen Steiner
- Seattle Children's Research Institute, Center for Child Health, Behavior and Development, Seattle, WA
| | | | - James P MacDonald
- Nationwide Children's Hospital, Sports Medicine, Columbus, OH
- Department of Pediatrics and Family Medicine, Ohio State University College of Medicine, Columbus, OH
| | - Christina L Master
- Children's Hospital of Philadelphia, Sports Medicine and Performance Center, Philadelphia, PA
- University of Pennsylvania Perelman School of Medicine, Department of Pediatrics, Philadelphia, PA
| | - Christopher C Giza
- David Geffen School of Medicine and UCLA Mattel Children's Hospital, Departments of Pediatrics and Neurosurgery, Los Angeles, CA; and
- UCLA Steve Tisch BrainSPORT Program, Los Angeles, CA
| | - Monique S Burton
- University of Washington School of Medicine, Department of Pediatrics, Seattle, WA
- Seattle Children's Research Institute, Center for Clinical and Translational Research, Seattle, WA
- University of Washington School of Medicine, Department of Orthopedics and Sports Medicine, Seattle, WA
- Seattle Children's Hospital, Orthopedics and Sports Medicine, Seattle, WA
| | - Celeste Quitiquit
- University of Washington School of Medicine, Department of Pediatrics, Seattle, WA
- Seattle Children's Research Institute, Center for Clinical and Translational Research, Seattle, WA
- University of Washington School of Medicine, Department of Orthopedics and Sports Medicine, Seattle, WA
- Seattle Children's Hospital, Orthopedics and Sports Medicine, Seattle, WA
| | - Brian J Krabak
- University of Washington School of Medicine, Department of Orthopedics and Sports Medicine, Seattle, WA
- Seattle Children's Hospital, Orthopedics and Sports Medicine, Seattle, WA
| | - Jeanette P Kotch
- University of Washington School of Medicine, Department of Orthopedics and Sports Medicine, Seattle, WA
| | - Frederick P Rivara
- University of Washington School of Medicine, Department of Pediatrics, Seattle, WA
- Seattle Children's Research Institute, Center for Child Health, Behavior and Development, Seattle, WA
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Koller D, Espin S, Indar A, Oulton A, LeGrow K. Children's participation rights and the role of pediatric healthcare teams: A critical review. J Pediatr Nurs 2024; 77:1-12. [PMID: 38461775 DOI: 10.1016/j.pedn.2024.02.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/01/2024] [Revised: 02/16/2024] [Accepted: 02/26/2024] [Indexed: 03/12/2024]
Abstract
AIM A critical review examined how childrens participation rights as represented in the United Nations Convention on the Rights of the Child inform the work of pediatric teams in healthcare settings. METHODS We systematically searched peer-reviewed literature on the enactment of child participation rights, within the context of pediatric teams. Articles were evaluated using the LEGEND (Let Evidence Guide Every New Decision) tool. Data extraction and analysis highlighted themes and disparities between articles, as well as gaps. A total of 25 studies were selected. RESULTS We reviewed studies from around the globe, with the majority of papers from the UK. Qualitative and mixed methods approaches were administered. The following observations were made: (1) limited language of children's rights exists in the literature, (2) lack of information regarding the composition of pediatric healthcare teams and how they work with children, (3) children's perspectives on what constitutes good interactions with healthcare providers are replicated, (4) minimal references to theory or philosophical underpinnings that can guide practice. CONCLUSION Explicit references to children's participation rights are lacking in the literature which may reflect the absence of rights language that could inform pediatric practice. Descriptive understandings of the tenets of pediatric interprofessional team composition and collaboration are necessary if we are to imagine the child as part of the team along with their family. Despite these shortcomings, the literature alludes to children's ability to discern desirable interactions with healthcare providers.
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Affiliation(s)
- Donna Koller
- School of Early Childhood Studies, Toronto Metropolitan University, Toronto, Canada.
| | - Sherry Espin
- Daphne Cockwell School of Nursing, Toronto Metropolitan University, Toronto, Canada
| | - Alyssa Indar
- Nova Scotia Health/Dalhousie University, Halifax, Canada
| | - Angie Oulton
- School of Early Childhood Studies, Toronto Metropolitan University, Toronto, Canada
| | - Karen LeGrow
- Daphne Cockwell School of Nursing, Toronto Metropolitan University, Toronto, Canada
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Görig T, Eichinger M, Georg S, Hoffmann D, Philippi H, König J, Urschitz MS, De Bock F. Correlates of perceived shared decision making with parents of children with special healthcare needs: Findings from the PART-CHILD study. PATIENT EDUCATION AND COUNSELING 2024; 124:108252. [PMID: 38503036 DOI: 10.1016/j.pec.2024.108252] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/13/2023] [Revised: 02/20/2024] [Accepted: 03/13/2024] [Indexed: 03/21/2024]
Abstract
OBJECTIVE To assess the extent of perceived shared decision making (SDM) with parents of pediatric patients and to examine its association with characteristics of patients, professionals, and healthcare facilities. METHODS Parents of pediatric patients (n = 4383) were recruited in 15 social pediatric centers in Germany and provided information on perceived SDM (binary CollaboRATEpediatric score: optimal versus suboptimal extent of SDM), child age and sex, type of impairment, appointment, and healthcare professional present at the appointment. Organizational characteristics were assessed in a cross-sectional survey of staff at the study sites. RESULTS Overall, 58.4% of parents reported an optimal extent of SDM. The optimal extent of SDM was more likely reported by parents of girls (OR=1.27, p < 0.001) and children with physical (as opposed to cognitive and combined) impairments (OR=1.30, p = 0.006), and after appointments attended by allied health professionals (OR=1.28, p = 0.004). In addition, parents in facilities receiving financing in addition to compensation by statutory health insurance funds were less likely to report an optimal extent of perceived SDM. CONCLUSION While SDM with parents was mostly related to individual characteristics of children and professionals at appointments, organizational characteristics seemed less relevant in our study. PRACTICE IMPLICATIONS Staff should be made aware of lower SDM with parents of boys, older children, and those with cognitive impairments, and trained to improve the SDM in these groups.
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Affiliation(s)
- Tatiana Görig
- Department of Medical Informatics, Biometry and Epidemiology, Professorship of Epidemiology and Public Health, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Erlangen, Germany.
| | - Michael Eichinger
- Center for Preventive Medicine and Digital Health, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany; Division of Pediatric Epidemiology, Institute of Medical Biostatistics, Epidemiology, and Informatics, University Medical Center of the Johannes Gutenberg-University Mainz, Mainz, Germany
| | - Sabine Georg
- Center for Preventive Medicine and Digital Health, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Dorle Hoffmann
- Division of Pediatric Epidemiology, Institute of Medical Biostatistics, Epidemiology, and Informatics, University Medical Center of the Johannes Gutenberg-University Mainz, Mainz, Germany
| | | | - Jochem König
- Division of Pediatric Epidemiology, Institute of Medical Biostatistics, Epidemiology, and Informatics, University Medical Center of the Johannes Gutenberg-University Mainz, Mainz, Germany
| | - Michael S Urschitz
- Division of Pediatric Epidemiology, Institute of Medical Biostatistics, Epidemiology, and Informatics, University Medical Center of the Johannes Gutenberg-University Mainz, Mainz, Germany
| | - Freia De Bock
- Department of General Pediatrics, Neonatology and Pediatric Cardiology, Medical Faculty, University Hospital Düsseldorf, Heinrich-Heine-University Düsseldorf, Düsseldorf, Germany
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Nagra A, Fuller ID, Connett G, Reynolds BC, Tyerman K, Wallace D, Preka E, Armstrong K, Patel N, Shameti S, Edelman J, Dempsey R, Anderson CE, Gilbert R, Haq MR, Harmer M, Tse Y. Fifteen-minute consultation: Empowering children, young people and families through shared decision-making: a practical guide. Arch Dis Child Educ Pract Ed 2024:edpract-2023-325513. [PMID: 38937065 DOI: 10.1136/archdischild-2023-325513] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2023] [Accepted: 02/29/2024] [Indexed: 06/29/2024]
Abstract
Shared decision-making (SDM) is a collaborative approach to healthcare decision-making that involves patients and healthcare professionals working together to make decisions that are informed by the best available medical evidence, as well as the patient's values, preferences and goals. The importance of SDM and the intricate interplay among parents, children and young people (CYP), and healthcare professionals are increasingly acknowledged as the crucial aspects of delivering high-quality paediatric care. While there is a substantial evidence base for SDM improving knowledge and reducing decisional conflict, the evidence for long-term measures such as improved health outcomes is limited and mainly inconclusive. To support healthcare teams in implementing SDM, the authors offer a practical guide to enhance decision-making processes and empower CYP and their families.
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Affiliation(s)
- Arvind Nagra
- Department of Nephro-Urology, Southampton Children's Hospital, Southampton, UK
| | | | - Gary Connett
- Department of Paediatric Respiratory Medicine, University Hospitals Southampton, NHS Foundation Trust, Southampton, UK
| | - Ben C Reynolds
- Paediatric Renal Unit, Royal Hospital for Children, Glasgow, UK
| | - Kay Tyerman
- Paediatric Nephrology, Leeds General Infirmary, Leeds, UK
| | - Dean Wallace
- Department of Paediatric Nephrology, Royal Manchester Children's Hospital, Manchester, UK
| | | | - Kirsten Armstrong
- University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | | | - Sarah Shameti
- Department of Nephro-Urology, Southampton Children's Hospital, Southampton, UK
| | - James Edelman
- Paediatric High Dependancy Unit, Southampton Children's Hospital, Southampton, UK
| | - Rosemary Dempsey
- Department of Pharmacy, Southampton Children's Hospital, Southampton, UK
| | - Caroline Elizabeth Anderson
- Dietetics, University Hospital Southampton NHS Foundation Trust, Southampton, UK
- Biomedical Research Unit, University of Southampton, Southampton, UK
| | - Rodney Gilbert
- Regional Paediatric Nephro-Urology Unit, Southampton Children's Hospital, Tremona Road, Southampton and Faculty of Medicine, University of Southampton, Southampton, UK
- Faculty of Medicine, University of Southampton, Southampton, UK
| | - Mushfequr R Haq
- Department of Nephro-Urology, Southampton Children's Hospital, Southampton, UK
| | - Matthew Harmer
- Department of Nephro-Urology, Southampton Children's Hospital, Southampton, UK
| | - Yincent Tse
- Department of Paediatric Nephrology, Great North Children's Hospital, Newcastle upon Tyne, UK
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Gill PJ, Buchanan F, Fahim C, Borkhoff CM, Raza S, Buba M, Wahi G, Bayliss A, Zhou K, Kanani R, Sakran M, De Castris-Garcia K, Barrowman N, Klassen T, Schuh S, Hulst J, Straus S, Macarthur C, Sozer A, Elwyn G, Breen-Reid K, Mahant S. Parenteral versus enteral fluids for infants hospitalized with bronchiolitis: The PREFER shared decision-making prospective observational study protocol. J Hosp Med 2024. [PMID: 38923338 DOI: 10.1002/jhm.13426] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2024] [Revised: 05/16/2024] [Accepted: 05/19/2024] [Indexed: 06/28/2024]
Abstract
INTRODUCTION Incorporating shared decision-making (SDM) with children and families in hospitals was a top priority identified by patients, caregivers, and clinicians. Bronchiolitis, a common and costly reason for hospitalization in children, is an exemplar condition to study SDM in hospitals. Internationally, clinical practice guidelines differ when recommending intravenous (IV or parenteral) or nasogastric (NG or enteral) fluids for hospitalized infants with bronchiolitis who are unsafe to be fed orally. While evidence indicates that either IV or NG fluids are safe and effective, parent involvement in SDM in selecting IV or NG fluids is unknown. Our aim is to generate knowledge of SDM with parents in choosing between IV or NG fluids and the benefits and harms of these two treatment options for hospitalized children with bronchiolitis. METHOD This is a multicenter, prospective, observational study, including children aged <12 months admitted to hospital with bronchiolitis requiring supplemental IV or NG fluids. The primary outcome will evaluate the extent of SDM in choosing IV versus NG fluids using the validated CollaboRATE tool. Secondary outcomes include the proportion of parents provided a choice of IV versus NG fluids; parent knowledge of fluid therapy; rate of fluids; length of hospital stay; and complications. DISCUSSION This study will evaluate the extent of SDM in hospitalized infants with bronchiolitis who require IV or NG fluids and will evaluate both patient-centered and clinical outcomes that are relevant to clinical practice.
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Affiliation(s)
- Peter J Gill
- Division of Pediatric Medicine, The Hospital for Sick Children, Toronto, Ontario, Canada
- Department of Pediatrics, University of Toronto, Toronto, Ontario, Canada
- Child Health Evaluative Sciences, SickKids Research Institute, The Hospital for Sick Children, Toronto, Ontario, Canada
- Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, The University of Toronto, Toronto, Ontario, Canada
| | - Francine Buchanan
- Division of Pediatric Medicine, The Hospital for Sick Children, Toronto, Ontario, Canada
- Child Health Evaluative Sciences, SickKids Research Institute, The Hospital for Sick Children, Toronto, Ontario, Canada
- Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, The University of Toronto, Toronto, Ontario, Canada
| | - Christine Fahim
- Implementation, Evaluation and Sustainability, Knowledge Translation Program, St Michael's Hospital Li Ka Shing Knowledge Institute, Toronto, Ontario, Canada
| | - Cornelia M Borkhoff
- Division of Pediatric Medicine, The Hospital for Sick Children, Toronto, Ontario, Canada
- Department of Pediatrics, University of Toronto, Toronto, Ontario, Canada
- Child Health Evaluative Sciences, SickKids Research Institute, The Hospital for Sick Children, Toronto, Ontario, Canada
- Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, The University of Toronto, Toronto, Ontario, Canada
| | - Shamama Raza
- Child Health Evaluative Sciences, SickKids Research Institute, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Melanie Buba
- Division of Pediatric Medicine, Children's Hospital of Eastern Ontario, Ottawa, Ontario, Canada
- Department of Pediatrics, University of Ottawa, Ottawa, Ontario, Canada
- Children's Hospital of Eastern Ontario Research Institute, Ottawa, Ontario, Canada
| | - Gita Wahi
- Department of Pediatrics, McMaster University, Hamilton, Ontario, Canada
- McMaster Children's Hospital, Hamilton, Ontario, Canada
| | - Ann Bayliss
- Department of Paediatrics, Trillium Health Partners Credit Valley Hospital, Mississauga, Ontario, Canada
| | - Kim Zhou
- Department of Pediatrics, North York General Hospital, Toronto, Ontario, Canada
| | - Ronik Kanani
- Department of Pediatrics, North York General Hospital, Toronto, Ontario, Canada
| | - Mahmoud Sakran
- Department of Pediatrics, Lakeridge Health, Oshawa, Ontario, Canada
- Department of Pediatrics, Queen's University, Kingston, Ontario, Canada
| | - Kim De Castris-Garcia
- Child Health Evaluative Sciences, SickKids Research Institute, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Nicholas Barrowman
- Children's Hospital of Eastern Ontario Research Institute, Ottawa, Ontario, Canada
| | - Terry Klassen
- Children's Hospital Research Institute of Manitoba, Winnipeg, Manitoba, Canada
- Department of Pediatrics & Child Health, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Suzanne Schuh
- Department of Pediatrics, University of Toronto, Toronto, Ontario, Canada
- Child Health Evaluative Sciences, SickKids Research Institute, The Hospital for Sick Children, Toronto, Ontario, Canada
- Division of Pediatric Emergency Medicine, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | - Jessie Hulst
- Department of Pediatrics, University of Toronto, Toronto, Ontario, Canada
- Division of Pediatric Gastroenterology, Hepatology and Nutrition, The Hospital for Sick Children, Toronto, Ontario, Canada
- Department of Nutritional Sciences, University of Toronto, Toronto, Ontario, Canada
| | - Sharon Straus
- Implementation, Evaluation and Sustainability, Knowledge Translation Program, St Michael's Hospital Li Ka Shing Knowledge Institute, Toronto, Ontario, Canada
- Department of Medicine, University of Toronto, Toronto, Ontario, Canada
- Division of Geriatrics, St. Michael's Hospital, Toronto, Ontario, Canada
| | - Colin Macarthur
- Department of Pediatrics, University of Toronto, Toronto, Ontario, Canada
- Child Health Evaluative Sciences, SickKids Research Institute, The Hospital for Sick Children, Toronto, Ontario, Canada
- Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, The University of Toronto, Toronto, Ontario, Canada
| | - Aubrey Sozer
- Division of Pediatric Medicine, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Glyn Elwyn
- The Dartmouth Institute for Health Policy & Clinical Practice, Geisel School of Medicine, Dartmouth College, Lebanon, New Hampshire, USA
| | - Karen Breen-Reid
- Division of Pediatric Medicine, The Hospital for Sick Children, Toronto, Ontario, Canada
- Lawrence S Bloomberg Faculty of Nursing, University of Toronto, Toronto, Ontario, Canada
| | - Sanjay Mahant
- Division of Pediatric Medicine, The Hospital for Sick Children, Toronto, Ontario, Canada
- Department of Pediatrics, University of Toronto, Toronto, Ontario, Canada
- Child Health Evaluative Sciences, SickKids Research Institute, The Hospital for Sick Children, Toronto, Ontario, Canada
- Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, The University of Toronto, Toronto, Ontario, Canada
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Nisius K, Hoffmann D, Görig T, Georg S, Krug K, De Bock F, Eichinger M. Perceived shared decision making and satisfaction with care among children and adolescents with special healthcare needs and their parents: Cross-sectional evidence from the PART-CHILD Study. PATIENT EDUCATION AND COUNSELING 2024; 123:108175. [PMID: 38492427 DOI: 10.1016/j.pec.2024.108175] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/24/2023] [Revised: 12/28/2023] [Accepted: 01/24/2024] [Indexed: 03/18/2024]
Abstract
OBJECTIVES To compare shared decision making (SDM) and satisfaction with care (SWC), an indicator of care quality, between children with special healthcare needs (CSHCN) and parents and to assess the association between SDM and SWC in both groups. METHODS We recruited CSHCN ≥ 7 years and parents from 15 outpatient facilities that completed a paper questionnaire assessing SDM (highest vs. lower levels of SDM) and SWC. Differences in SDM and SWC were assessed with McNemar and paired t-tests. We used adjusted linear mixed models to investigate cross-sectional associations between SDM and SWC. RESULTS Based on data from 275 CSHCN and 858 parents, 39% and 64% of CSHCN and parents reported the highest level of SDM (p < 0.0001). No difference in SWC was observed (p = 0.36). Perceived SDM was associated with SWC in both groups (both p < 0.0001). CONCLUSION Associations between SDM and SWC reinforce the role of SDM for care quality. Large proportions of CSHCN and parents reporting suboptimal levels of SDM highlight the need for effective programs to promote SDM in the target population. PRACTICE IMPLICATIONS Until effective programs become available, healthcare professionals can use existing opportunities to involve CSHCN and parents in consultations (e.g., provide sufficient opportunities to ask questions).
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Affiliation(s)
- Katja Nisius
- Center for Preventive Medicine and Digital Health, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Dorle Hoffmann
- Institute of Medical Biostatistics, Epidemiology and Informatics, University Medical Center of the Johannes Gutenberg-University Mainz, Mainz, Germany
| | - Tatiana Görig
- Department of Medical Informatics, Biometry and Epidemiology, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany
| | - Sabine Georg
- Center for Preventive Medicine and Digital Health, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Katja Krug
- Department of General Practice and Health Services Research, University Hospital Heidelberg, Heidelberg, Germany
| | - Freia De Bock
- Department of General Pediatrics, Neonatology and Pediatric Cardiology, Medical Faculty, University Hospital Düsseldorf, Heinrich-Heine-University Düsseldorf, Düsseldorf, Germany
| | - Michael Eichinger
- Center for Preventive Medicine and Digital Health, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany; Institute of Medical Biostatistics, Epidemiology and Informatics, University Medical Center of the Johannes Gutenberg-University Mainz, Mainz, Germany.
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8
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Walter J, Hill DL, Cetin A, DeWitt A, Kellom K, Quarshie W, Griffis H, Shults J, Arnold R, Tjia J, Puopolo K, Curley MAQ, Feudtner C. A Pediatric Interprofessional Cardiac Intensive Care Unit Intervention: CICU Teams and Loved Ones Communicating (CICU TALC) is Feasible, Acceptable, and Improves Clinician Communication Behaviors in Family Meetings. Pediatr Cardiol 2024:10.1007/s00246-024-03497-7. [PMID: 38700711 DOI: 10.1007/s00246-024-03497-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2024] [Accepted: 04/11/2024] [Indexed: 07/17/2024]
Abstract
Parents of children in the pediatric cardiac intensive care unit (CICU) are often unprepared for family meetings (FM). Clinicians often do not follow best practices for communicating with families, adding to distress. An interprofessional team intervention for FM is feasible, acceptable, and positively impacts family preparation and conduct of FM in the CICU. We implemented a family- and team-support intervention for conducting FM and conducted a pretest-posttest study with parents of patients selected for a FM and clinicians. We measured feasibility, fidelity to intervention protocol, and parent acceptability via questionnaire and semi-structured interviews. Clinician behavior in meetings was assessed through semantic content analyses of meeting transcripts tracking elicitation of parental concerns, questions asked of parents, and responses to parental empathic opportunities. Logistic and ordinal logistic regression assessed intervention impact on clinician communication behaviors in meetings comparing pre- and post-intervention data. Sixty parents (95% of approached) were enrolled, with collection of 97% FM and 98% questionnaire data. We accomplished > 85% fidelity to intervention protocol. Most parents (80%) said the preparation worksheet had the right amount of information and felt positive about families receiving this worksheet. Clinicians were more likely to elicit parental concerns (adjusted odds ratio = 3.42; 95%CI [1.13, 11.0]) in post-intervention FM. There were no significant differences in remaining measures. Implementing an interprofessional team intervention to improve family preparation and conduct of FM is locally feasible, acceptable, and changes clinician behaviors. Future research should assess broader impact of training on clinicians, patients, and families.
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Affiliation(s)
- Jennifer Walter
- Clinical Futures, Children's Hospital of Philadelphia, Philadelphia, PA, USA.
- Justin Ingerman Center for Palliative Care, Children's Hospital of Philadelphia, Philadelphia, PA, USA.
| | - Douglas L Hill
- Justin Ingerman Center for Palliative Care, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Arzu Cetin
- Clinical Futures, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Aaron DeWitt
- Cardiac Center, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Katie Kellom
- Policy Lab, Children's Hospital of Philadelphia, Philadelphia, PA, USA
- Qualitative Research Core, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - William Quarshie
- Data Science and Biostatistics Unit, Department of Biomedical and Health Informatics, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Heather Griffis
- Data Science and Biostatistics Unit, Department of Biomedical and Health Informatics, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Justine Shults
- Department of Biostatistics, Epidemiology, and Informatics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Robert Arnold
- University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Jennifer Tjia
- Department of Population and Quantitative Health Sciences, UMass Chan Medical School, Worcester, MA, USA
| | - Karen Puopolo
- Clinical Futures, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Martha A Q Curley
- Department of Family and Community Health, University of Pennsylvania School of Nursing, Philadelphia, PA, USA
- Children's Hospital of Philadelphia Research Institute, Philadelphia, PA, USA
| | - Chris Feudtner
- Clinical Futures, Children's Hospital of Philadelphia, Philadelphia, PA, USA
- Justin Ingerman Center for Palliative Care, Children's Hospital of Philadelphia, Philadelphia, PA, USA
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9
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Ronde E, van de Lücht VA, Lachkar N, Ubbink DT, Breugem CC. Stakeholders' Views on Information Needed in a Patient Decision Aid for Microtia Reconstruction. Cleft Palate Craniofac J 2024; 61:854-869. [PMID: 36604964 PMCID: PMC10981206 DOI: 10.1177/10556656221146584] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
OBJECTIVE To assess which information about microtia and the possible reconstructive options health care providers (HCPs), patients and parents believe should be included in a patient decision aid (PtDA). DESIGN A mixed-methods study comprised of an online survey of HCPs and focus group discussions with patients and parents. PARTICIPANTS Survey respondents were members of the International Society for Auricular Reconstruction (ISAR). Focus group participants were patients with microtia and their parents, recruited through the microtia outpatient clinic at Amsterdam UMC, and through a Dutch patient organization for cleft and craniofacial conditions. METHODS An online, investigator-made survey was sent to ISAR members in December 2021. Semi-structured focus group discussions were held in February 2022. Quantitative results were summarized, and qualitative results were thematically grouped. RESULTS Thirty-two HCPs responded to the survey (response rate 41%). Most respondents (n = 24) were plastic surgeons, who had a median of 15 years of experience (IQR: 7-23 years). Two focus groups were held with a total of five patients and two parents. HCPs, patients and parents generally agreed on the information needed in a PtDA, emphasizing the importance of realistic expectation management. Patients and parents also considered psychosocial and functional outcomes, patient experiences, as well as patients' involvement in decision-making important. CONCLUSIONS A PtDA for microtia reconstruction should target all patients with microtia, and include information on at least technique-related information, expected esthetic results, possible adverse effects, psychosocial and functional outcomes and patient experiences. Preference eliciting questions should be developed for both pediatric patients and their parents.
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Affiliation(s)
- E.M. Ronde
- Department of Plastic, Reconstructive and Hand Surgery, Amsterdam UMC location University of Amsterdam, Amsterdam, the Netherlands
- Amsterdam Reproduction and Development, Amsterdam, the Netherlands
| | - Veronique A.P. van de Lücht
- Department of Plastic, Reconstructive and Hand Surgery, Amsterdam UMC location University of Amsterdam, Amsterdam, the Netherlands
| | - N. Lachkar
- Department of Plastic, Reconstructive and Hand Surgery, Amsterdam UMC location University of Amsterdam, Amsterdam, the Netherlands
| | - Dirk T. Ubbink
- Department of Surgery, Amsterdam UMC location University of Amsterdam, Amsterdam, the Netherlands
- Personalized Medicine, Amsterdam Public Health, Amsterdam, the Netherlands
| | - Corstiaan C. Breugem
- Department of Plastic, Reconstructive and Hand Surgery, Amsterdam UMC location University of Amsterdam, Amsterdam, the Netherlands
- Amsterdam Reproduction and Development, Amsterdam, the Netherlands
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Wu QL, Brannon GE. Collaborative Care and Healthcare Usage in Families with Pediatric Patients During COVID-19: A Secondary Analysis of National Survey of Children's Health (NSCH) Data. HEALTH COMMUNICATION 2024; 39:1053-1065. [PMID: 37069500 DOI: 10.1080/10410236.2023.2201746] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/19/2023]
Abstract
One of the most detrimental side effects of the COVID-19 pandemic is the needed but not received care. Forgone health care affects the general public, but particularly children with special care needs. Previous research focused on non-modifiable factors, such as demographic background and insurance coverage. Based on Politi and Street's model of collaborative decision-making, we explored how two modifiable communication factors contributed to the prevention of forgone pediatric care during the COVID-19 pandemic. Using a nationally representative sample (n = 10845) from the 2020 National Survey of Children's Health (NSCH) survey, we found that health-care providers' family-centered communication and shared decision-making may reduce the possibility of forgone care through improved satisfaction with providers' communication. For children with mental health needs, providers' family-centered communication may also stimulate family's capacity to openly communicate, leading to better involvement in care and timely health care seeking. This helps to address COVID-related uncertainty, prevent higher health-care expenditures, and reduce negative health outcomes.
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11
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Mack C, Mailo J, Ofosu D, Hinai AA, Keto-Lambert D, Soril LJJ, van Manen M, Castro-Codesal M. Tracheostomy and long-term invasive ventilation decision-making in children: A scoping review. Pediatr Pulmonol 2024; 59:1153-1164. [PMID: 38289099 DOI: 10.1002/ppul.26884] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2023] [Revised: 11/01/2023] [Accepted: 01/14/2024] [Indexed: 04/30/2024]
Abstract
An increasing number of children are surviving critical illnesses requiring tracheostomy/long-term ventilation (LTV). This scoping review seeks to collate the available evidence on decision-making for tracheostomy/LTV in children. Systematic searches of electronic databases and websites were conducted for articles and reports. Inclusion criteria included: (1) children 0-18 years old; (2) described use of tracheostomy or tracheostomy/LTV; and (3) information on recommendations for tracheostomy decision-making or decision-making experiences of family-caregivers or health care providers. Articles not written in English were excluded. Of the 4463 records identified through database search and other methods, a total of 84 articles, 2 dissertations, 1 book chapter, 3 consensus statement/society guidelines, and 8 pieces of grey literature were included. Main thematic domains identified were: (1) legal and moral standards for decision-making; (2) decision-making models, roles of decision-makers, and decisional aids towards a shared decision-making model; (3) experiences and perspectives of decision-makers; (4) health system and society considerations; and (5) conflict resolution and legal considerations. A high degree of uncertainty and complexity is involved in tracheostomy/LTV decision-making. There is a need for a standardized decision-support process that is consistent with a child's best interests and shared decision-making. Strategies for optimizing communication and mechanism for managing disputes are needed.
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Affiliation(s)
- Cheryl Mack
- Department of Pediatrics, University of Alberta, Edmonton, Alberta, Canada
- Department of Anesthesiology and Pain Medicine, University of Alberta, Edmonton, Alberta, Canada
| | - Janette Mailo
- Department of Pediatrics, University of Alberta, Edmonton, Alberta, Canada
| | - Daniel Ofosu
- Department of Pediatrics, University of Alberta, Edmonton, Alberta, Canada
| | - Alreem A Hinai
- Division of Pediatric Surgery, Department of Surgery, University of British Columbia, Vancouver, British Columbia, Canada
| | - Diana Keto-Lambert
- Cummings School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Lesley J J Soril
- Division of General Internal Medicine, Department of Medicine, University of Alberta, Edmonton, Alberta, Canada
- Medicine Strategic Clinical Network, Alberta Health Services, Edmonton, Alberta, Canada
| | - Michael van Manen
- Department of Pediatrics, University of Alberta, Edmonton, Alberta, Canada
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12
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Gramszlo C, Karpyn A, Christofferson J, McWhorter LG, Demianczyk AC, Neely T, Zyblewski S, Shillingford A, Kazak AE, Sood E. Meeting Parents' Needs for Education and Preparation following Congenital Heart Disease Diagnosis: Recommendations from a Crowdsourced Study. Am J Perinatol 2024; 41:e446-e455. [PMID: 35863373 PMCID: PMC10008463 DOI: 10.1055/a-1906-8786] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Abstract
OBJECTIVE This article characterizes the educational needs of parents following fetal or neonatal congenital heart disease (CHD) diagnosis and generates recommendations for meeting these needs. STUDY DESIGN Online crowdsourcing methods were used to collect qualitative data from 95 parents of children with CHD regarding their needs for education and preparation following fetal or neonatal diagnosis. Data were analyzed using qualitative methods and themes were organized around the substructure of met and unmet needs. RESULTS Two themes represented consistently met needs, whereas 10 themes represented needs that were either inconsistently met or consistently unmet. Parents reported needing more information about social, emotional, and financial supports, preparation for long-term care, and guidance toward reputable online resources. Parents also provided recommendations for meeting these needs. CONCLUSION Parents' needs for education and preparation following CHD diagnosis are much broader in scope than what they currently receive. Addressing these may support parental coping and active participation in medical decision-making. KEY POINTS · CHD counseling after diagnosis may provide opportunities to promote parents' mental health.. · Guidelines recommend that this counseling should include emotional and decision-making support, however, it is unclear what parents actually receive.. · This study found that parents' needs for education and preparation following CHD diagnosis are much broader in scope than what they currently receive..
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Affiliation(s)
- Colette Gramszlo
- Nemours Cardiac Center, Nemours Children’s Hospital, Delaware, Wilmington, DE
| | - Allison Karpyn
- Center for Research in Education and Social Policy, Department of Human Development and Family Sciences, University of Delaware, Newark, DE
| | | | - Linda G. McWhorter
- Division of Behavioral Health, Nemours Children’s Hospital, Delaware, Wilmington, DE
| | - Abigail C. Demianczyk
- Department of Psychiatry and Behavioral Sciences, Children’s Hospital of Philadelphia, Philadelphia, PA
| | - Trent Neely
- Brothers by Heart/Sisters by Heart, El Segundo, CA
| | - Sinai Zyblewski
- Department of Pediatrics, Medical University of South Carolina, Charleston, SC
| | - Amanda Shillingford
- Department of Psychiatry and Behavioral Sciences, Children’s Hospital of Philadelphia, Philadelphia, PA
| | - Anne E. Kazak
- Center for Healthcare Delivery Science, Nemours Children’s Health System, Wilmington, DE
- Department of Pediatrics, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA
| | - Erica Sood
- Nemours Cardiac Center, Nemours Children’s Hospital, Delaware, Wilmington, DE
- Center for Healthcare Delivery Science, Nemours Children’s Health System, Wilmington, DE
- Division of Behavioral Health, Nemours Children’s Hospital, Delaware, Wilmington, DE
- Department of Pediatrics, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA
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13
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Michinobu R, Yamamoto M, Igarashi K, Sakai Y, Akane Y, Yamamoto D, Takebayashi A, Mikami T, Tsutsumi H, Tsugawa T. Children's cognition and attitudes during long-term cancer treatment: an ethnographic study. BMJ Paediatr Open 2024; 8:e002405. [PMID: 38627059 PMCID: PMC11029233 DOI: 10.1136/bmjpo-2023-002405] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2023] [Accepted: 04/02/2024] [Indexed: 04/19/2024] Open
Abstract
BACKGROUND Cancer treatment for children is typically long-term and difficult, and the experience is unique for each child. When designing child-centred care, individuals' values and preferences are considered equally important as the clinical evidence; therefore, understanding children's thoughts and attitudes while they receive long-term treatment could offer valuable insights for better clinical practice. METHODS We conducted long-term consecutive participatory observations and interviews with seven children, who were hospitalised and receiving cancer treatment for the first time. The daily observational data on those children's discourses, behaviours and interactions with health professionals were systematically collected and thematically examined. The analysis was expanded to explore significant narratives for each child to capture their narrative sequence over time. RESULTS The initial analysis identified 685 narrative indexes for all observation data, which were categorised into 21 sub-codes. Those sub-codes were assembled into five main themes by thematic analysis: making promises with health professionals, learning about the treatment procedures through participation, taking care of oneself, increasing the range of activities one can perform and living an ordinary life. CONCLUSION We observed a forward-looking attitude toward understanding cancer, accepting treatment and looking forward to the future among children undergoing in-hospital cancer treatment. In addition, the children developed cognitively, affectively and relationally throughout cancer treatment processes. These findings have implications for better clinical practice in child-centred care, including children's participation in shared decision-making in paediatric oncology.
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Affiliation(s)
- Ryoko Michinobu
- School of Nursing and Social Welfare Sciences, Fukui Prefectural University, Fukui, Japan
- Department of Pediatrics, Sapporo Medical University School of Medicine, Sapporo, Japan
| | - Masaki Yamamoto
- Department of Pediatrics, Sapporo Medical University School of Medicine, Sapporo, Japan
| | - Keita Igarashi
- Department of Pediatrics, Sapporo Medical University School of Medicine, Sapporo, Japan
- Department of Pediatric Hematology/Oncology, Hokkaido Medical Center for Child Health and Rehabilitation, Sapporo, Japan
| | - Yoshiyuki Sakai
- Department of Pediatrics, Hakodate Municipal Hospital, Hakodate, Japan
| | - Yusuke Akane
- Department of Pediatrics, Sapporo Medical University School of Medicine, Sapporo, Japan
| | - Dai Yamamoto
- Department of Pediatrics, Kushiro City General Hospital, Kushiro, Japan
| | - Akira Takebayashi
- Department of Pediatrics, Sapporo Medical University School of Medicine, Sapporo, Japan
| | - Takahiro Mikami
- Division of Pediatrics, Sapporo Medical University Hospital, Sapporo, Japan
| | - Hiroyuki Tsutsumi
- Department of Pediatrics, Sapporo Medical University School of Medicine, Sapporo, Japan
- Midorinosato, Saiseikai Otaru Hospital, Otaru, Japan
| | - Takeshi Tsugawa
- Department of Pediatrics, Sapporo Medical University School of Medicine, Sapporo, Japan
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14
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Valentine KD, Lipstein EA, Vo H, Cosenza C, Barry MJ, Mancini B, Brinkman WB, Sepucha K. Measure of Caregiver Attention-Deficit/Hyperactivity Disorder Knowledge Is Responsive to Decision Aid on Treatment for Attention-Deficit/Hyperactivity Disorder. Acad Pediatr 2024; 24:417-423. [PMID: 37536452 PMCID: PMC11182372 DOI: 10.1016/j.acap.2023.07.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2023] [Revised: 07/20/2023] [Accepted: 07/27/2023] [Indexed: 08/05/2023]
Abstract
OBJECTIVE Adapt and test a measure of knowledge for caregivers of children with attention-deficit/hyperactivity disorder (ADHD) and evaluate the impact of the information component of a decision aid (DA) on participant knowledge. METHODS A set of seven knowledge items were created based on prior knowledge measures and clinical guidelines. As part of a larger cross-sectional survey study of caregivers of children diagnosed with ADHD, caregivers were randomized to one of two arms: 1) a DA arm, where participants reviewed the information component of the Cincinnati Children's Hospital's DA, and 2) a control arm, where participants were not shown a DA. All participants completed the seven knowledge items. Knowledge items were assessed for difficulty, quality of distractors, acceptability, and redundancy. Total knowledge scores (0-100) for the DA and control arm were compared. RESULTS Caregivers were assigned to the DA arm (n = 243) or the control arm (n = 260). All 7 knowledge items were retained as no items were too difficult or too easy, all response options were used, there were little missing data, and no items were redundant. The overall knowledge score was normally distributed, and almost covered the full range of scores (5-100). Those who received the DA component had higher knowledge scores (M=68, SD=23) than those who did not receive the DA component (M=60, SD=19, P < .01, d=0.4). CONCLUSIONS The Caregiver ADHD Knowledge (CAKe) measure was acceptable and demonstrated construct validity as those who were assigned to review the DA component demonstrated greater knowledge than those who were not assigned to review the DA component.
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Affiliation(s)
- Kathrene Diane Valentine
- Department of General Internal Medicine, Massachusetts General Hospital (KD Valentine, H Vo, MJ Barry, B Mancini, and K Sepucha), Boston; Department of Medicine, Harvard Medical School (KD Valentine, MJ Barry, and K Sepucha), Boston, Mass.
| | - Ellen A Lipstein
- Department of Pediatrics, Cincinnati Children's Hospital Medical Center (EA Lipstein and WB Brinkman), Cincinnati, Ohio; Department of Pediatrics (EA Lipstein and WB Brinkman), University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - Ha Vo
- Department of General Internal Medicine, Massachusetts General Hospital (KD Valentine, H Vo, MJ Barry, B Mancini, and K Sepucha), Boston
| | - Carol Cosenza
- Center for Survey Research (C Cosenza), University of Massachusetts Boston
| | - Michael J Barry
- Department of General Internal Medicine, Massachusetts General Hospital (KD Valentine, H Vo, MJ Barry, B Mancini, and K Sepucha), Boston; Department of Medicine, Harvard Medical School (KD Valentine, MJ Barry, and K Sepucha), Boston, Mass
| | - Brittney Mancini
- Department of General Internal Medicine, Massachusetts General Hospital (KD Valentine, H Vo, MJ Barry, B Mancini, and K Sepucha), Boston
| | - William B Brinkman
- Department of Pediatrics, Cincinnati Children's Hospital Medical Center (EA Lipstein and WB Brinkman), Cincinnati, Ohio; Department of Pediatrics (EA Lipstein and WB Brinkman), University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - Karen Sepucha
- Department of General Internal Medicine, Massachusetts General Hospital (KD Valentine, H Vo, MJ Barry, B Mancini, and K Sepucha), Boston; Department of Medicine, Harvard Medical School (KD Valentine, MJ Barry, and K Sepucha), Boston, Mass
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15
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Park M, Doan TTT, Jung J, Giap TTT, Kim J. Decision aids for promoting shared decision-making: A review of systematic reviews. Nurs Health Sci 2024; 26:e13071. [PMID: 38356102 DOI: 10.1111/nhs.13071] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2023] [Revised: 11/03/2023] [Accepted: 12/03/2023] [Indexed: 02/16/2024]
Abstract
In the context of shared decision-making (SDM), experts have advocated the use of validated decision aids (DAs) as valuable tools for facilitating SDM in various healthcare scenarios. This comprehensive review attempts to analyze a vast corpus of DA research by performing thorough searches across four prominent databases (PubMed, CINAHL, Embase, and Web of Science). Independent reviewers selected relevant reviews, extracted data, and assessed review quality using the AMSTAR II tool. A total of 34 systematic reviews were identified and evaluated in this review, encompassing a wide range of outcomes associated with using DAs. These outcomes include patient knowledge, patient involvement in SDM, decision conflict, decision regret, satisfaction, and adherence. In addition, DAs positively affect healthcare provider outcomes by increasing satisfaction, reducing decision conflicts, and lengthening clinical consultations. This review highlights the need for additional research in specific contexts such as long-term care, mental health, and reproductive health to better understand the benefits and challenges of implementing DAs in these settings. Such research can contribute to the improvement of SDM practices and patient-centered care.
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Affiliation(s)
- Myonghwa Park
- Education and Research Center for Evidence-Based Nursing Knowledge, College of Nursing, Chungnam National University, Daejeon, Republic of Korea
| | - Thao Thi-Thu Doan
- Education and Research Center for Evidence-Based Nursing Knowledge, College of Nursing, Chungnam National University, Daejeon, Republic of Korea
- Faculty of Nursing, Hai Phong University of Medicine and Pharmacy, Hai Phong, Vietnam
| | - Jihye Jung
- Education and Research Center for Evidence-Based Nursing Knowledge, College of Nursing, Chungnam National University, Daejeon, Republic of Korea
| | - Thi-Thanh-Tinh Giap
- Education and Research Center for Evidence-Based Nursing Knowledge, College of Nursing, Chungnam National University, Daejeon, Republic of Korea
- College of Health Sciences, Vin University, Hanoi, Vietnam
| | - Jinju Kim
- Education and Research Center for Evidence-Based Nursing Knowledge, College of Nursing, Chungnam National University, Daejeon, Republic of Korea
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16
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Wijngaarde R, Koning M, Fijnvandraat K, Ubbink D. Shared decision-making between paediatric haematologists, children with sickle cell disease and their parents: an exploratory study. Eur J Pediatr 2024; 183:389-402. [PMID: 37906307 PMCID: PMC10857996 DOI: 10.1007/s00431-023-05280-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2023] [Revised: 10/09/2023] [Accepted: 10/11/2023] [Indexed: 11/02/2023]
Abstract
Children with sickle cell disease (SCD) face various healthcare choices to be made during the disease process that may impact their lives. Shared decision-making (SDM) could improve their health outcomes. We assessed if, and to what extent, paediatricians engage children with SCD and/or their parents in the decision-making process. In this observational cross-sectional study, paediatric SCD patients and their parents visiting the outpatient paediatrics clinic of a university hospital participated in a SDM baseline measurement. Two evaluators independently and objectively analysed the level of patient involvement in decision-making from the audio-recordings of the consultations using the OPTION-5 instrument, a 0-20-point scale from which scores are usually expressed as a percentage of ideal SDM. The level of SDM, as perceived by patients, parents and paediatricians, was appreciated using the SDM-Q-9 and SDM-Q-Doc questionnaires, respectively. Scores could range from 0% (no SDM) to 100% (exemplary SDM). Twenty-four consultations in which a decision needed to be made about SCD treatment were audiotaped and analysed; six were from each paediatrician. The group consisted of 17 male and 7 female patients from various cultural backgrounds between 2 and 17 years old, with a mean age of 9.4 years (SD 4.2). Median OPTION-5 scores were 25.0% [IQR] 20.0-40.0%; range 0-55%). Median SDM-Q-9 and SDM-Q-Doc scores were 56.7% (IQR 39.4-88.9%) and 68.9% (IQR 57.8-77.8%), respectively. CONCLUSION Although subjective scores of SDM were fair, the objectively scored level of SDM among children suffering from SCD leaves room for improvement. This may be realized by increasing knowledge about the benefits of SDM, child-centred SDM interventions and SDM-training for paediatricians that takes into account the complexity of intercultural challenges and risk communication between stakeholders. WHAT IS KNOWN • Children that suffer from sickle cell disease (SCD) are more vulnerable to factors that negatively impact the care that they receive as well as suboptimal health outcomes. • Shared decision-making (SDM) can help children participate in a collaborative decision-making process about their preferred treatment options and improve their health outcomes. WHAT IS NEW • The level of participation in the decision-making process for patients suffering from SCD and the families that they belong to leaves room for improvement. The impact of intercultural challenges and the quality and consistency of risk-communication between stakeholders in paediatric SDM needs further exploration. • Paediatricians are more confident about their ability to involve the child and parents compared to how children and their parents experience their level of involvement in a shared decision-making process.
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Affiliation(s)
- Ricardo Wijngaarde
- Department of Surgery, Amsterdam University Medical Centers, University of Amsterdam, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands.
- Emma Children's Hospital, Amsterdam University Medical Centers, AMC, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands.
| | - Mijra Koning
- Alkmaar Medical Center, Department of Internal Medicine, Noordwest Ziekenhuisgroep, Wilhelminalaan 12, 1816 JD, Alkmaar, The Netherlands
| | - Karin Fijnvandraat
- Department of Pediatric Hematology, Amsterdam University Medical Centers, location University of Amsterdam, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands
| | - Dirk Ubbink
- Department of Surgery, Amsterdam University Medical Centers, University of Amsterdam, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands
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17
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Kavian JA. The Continuum of Medicine: Treating Patients Beyond Their Disease. Clin Pediatr (Phila) 2023:99228231220083. [PMID: 38135928 DOI: 10.1177/00099228231220083] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2023]
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18
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Alderson P, Bowman D, Brierley J, Dedieu N, Elliott MJ, Montgomery J, Wellesley H. Living bioethics, theories and children's consent to heart surgery. CLINICAL ETHICS 2023; 18:418-426. [PMID: 38024810 PMCID: PMC10654030 DOI: 10.1177/14777509221091086] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/01/2023]
Abstract
Background This analysis is about practical living bioethics and how law, ethics and sociology understand and respect children's consent to, or refusal of, elective heart surgery. Analysis of underlying theories and influences will contrast legalistic bioethics with living bioethics. In-depth philosophical analysis compares social science traditions of positivism, interpretivism, critical theory and functionalism and applies them to bioethics and childhood, to examine how living bioethics may be encouraged or discouraged. Illustrative examples are drawn from research interviews and observations in two London paediatric cardiac units. This paper is one of a series on how the multidisciplinary cardiac team members all contribute to the complex mosaic of care when preparing and supporting families' informed consent to surgery. Results The living bioethics of justice, care and respect for children and their consent depends on theories and practices, contexts and relationships. These can all be undermined by unseen influences: the history of adult-centric ethics; developmental psychology theories; legal and financial pressures that require consent to be defined as an adult contract; management systems and daily routines in healthcare that can intimidate families and staff; social inequalities. Mainstream theories in the clinical ethics literature markedly differ from the living bioethics in clinical practices. Conclusion We aim to contribute to raising standards of respectful paediatric bioethics and to showing the relevance of virtue and feminist ethics, childhood studies and children's rights.
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Affiliation(s)
| | | | - Joe Brierley
- Great Ormond Street Children’s Hospital, London, UK
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Buchanan CL, Morris MA, Matlock D, Kempe A, Vemulakonda VM. Parental experience and understanding of parent-provider discussions of treatment for infants with ureteropelvic junction obstruction. PEC INNOVATION 2023; 2:100142. [PMID: 37588298 PMCID: PMC10426279 DOI: 10.1016/j.pecinn.2023.100142] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 04/27/2022] [Revised: 02/16/2023] [Accepted: 02/18/2023] [Indexed: 08/18/2023]
Abstract
Objective The purpose of the current study was to understand what families identify as necessary information to guide decision-making in the treatment of their child with UPJO. Methods We conducted semi-structured interviews with parents of children with UPJO using phenomenological methodology. Data were systematically analyzed according to principles of thematic analysis, using a team-based inductive approach. Results 32 parents were interviewed. Findings are organized by three major themes including barriers to meaningful participation in decision making, logistical aspects of the decision, and psychosocial aspects of the decision. Conclusion These findings suggest the need to increase parent education and understanding around medical and surgical decision-making, and the need to enhance psychosocial support for more meaningful parental engagement in the surgical decision-making process. Practice implications The findings from the interviews highlight the importance of caregivers needing clear and accurate information in order to engage in meaningful discussions related to surgical decision-making for decisions around surgery for UPJO treatment.
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Affiliation(s)
- Cindy L. Buchanan
- Department of Psychiatry, University of Colorado School of Medicine, Aurora, USA
| | - Megan A. Morris
- Adult and Child Center for Outcomes Research and Delivery Science (ACCORDS), University of Colorado Anschutz Medical Campus, Aurora, USA
| | - Daniel Matlock
- Adult and Child Center for Outcomes Research and Delivery Science (ACCORDS), University of Colorado Anschutz Medical Campus, Aurora, USA
| | - Allison Kempe
- Adult and Child Center for Outcomes Research and Delivery Science (ACCORDS), University of Colorado Anschutz Medical Campus, Aurora, USA
| | - Vijaya M. Vemulakonda
- Department of Pediatric Urology, University of Colorado School of Medicine, Aurora, USA
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Horiuchi S, Nomura O, Curry L, Kushima M, Arnold L, Yamagata Z. 'Caregivers' awareness matters': Call for a child-centred approach to early detection of autism spectrum disorder through well-child visits in Japan. Child Care Health Dev 2023; 49:985-994. [PMID: 36807909 DOI: 10.1111/cch.13107] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2022] [Revised: 02/08/2023] [Accepted: 02/13/2023] [Indexed: 02/22/2023]
Abstract
BACKGROUND Early detection of autism spectrum disorder (ASD) is essential to provide children with timely treatment and support. Evidence-based screening measures make it possible to identify children with suspected ASD at an early stage. Although Japan has a universal healthcare system that covers well-child visits, detection rates of developmental disorders, including ASD, at 18 months vary widely between municipalities (0.2%-48.0%). The reasons for this high level of variation are poorly understood. The present study aims to describe the barriers and facilitators of incorporating ASD identification during well-child visits in Japan. METHODS This is a qualitative study that conducts semi-structured in-depth interviews in two municipalities of Yamanashi Prefecture. We recruited all public health nurses (n = 17) and paediatricians (n = 11) involved in the well-child visit in each municipality and caregivers of children who also participated in the visits during the study period (n = 21). RESULTS We identified four themes characterizing the process of ASD identification in the target municipalities: (1) Identification of children with ASD is driven by caregivers' sense of concern, acceptance and awareness. (2) Multidisciplinary cooperation and shared decision-making is limited. (3) Skills and training for developmental disabilities screening are underdeveloped. (4) Caregivers' expectations shape the interaction in important ways. CONCLUSIONS Non-standardization of screening methods, limited knowledge and skills on screening and child development among healthcare providers and poor coordination among healthcare providers and caregivers are the main barriers to effective early detection of ASD through well-child visits. The findings suggest the importance of promoting a child-centred care approach through the application of evidence-based screening measures and effective information sharing.
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Affiliation(s)
- Sayaka Horiuchi
- Department of Health Sciences, Division of Medicine, Graduate School Department of Interdisciplinary Research, University of Yamanashi, Yamanashi, Japan
| | - Osamu Nomura
- Department of Health Sciences Education, Hirosaki University, Aomori, Japan
- Centre for Community-based Health Professions Education, Hirosaki University, Aomori, Japan
| | - Leslie Curry
- Global Health Leadership Initiative, Yale School of Public Health, New Haven, Connecticut, USA
| | - Megumi Kushima
- Center for Birth Cohort Studies, University of Yamanashi, Yamanashi, Japan
| | - Linda Arnold
- Global Health Leadership Initiative, Yale School of Public Health, New Haven, Connecticut, USA
- International Pediatric Association (IPA), IPA-LEAD program, Marengo, Illinois, USA
| | - Zentaro Yamagata
- Department of Health Sciences, Division of Medicine, Graduate School Department of Interdisciplinary Research, University of Yamanashi, Yamanashi, Japan
- Center for Birth Cohort Studies, University of Yamanashi, Yamanashi, Japan
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21
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Opel DJ, Vo HH, Dundas N, Spielvogle H, Mercer A, Wilfond BS, Clark J, Heike CL, Weiss EM, Bryan MA, Shah SK, McCarty CA, Robinson JD, Blumenthal-Barby J, Tilburt J. Validation of a Process for Shared Decision-Making in Pediatrics. Acad Pediatr 2023; 23:1588-1597. [PMID: 36682451 DOI: 10.1016/j.acap.2023.01.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/14/2022] [Revised: 01/10/2023] [Accepted: 01/16/2023] [Indexed: 01/21/2023]
Abstract
OBJECTIVE We sought to confirm, refute, or modify a 4-step process for implementing shared decision-making (SDM) in pediatrics that involves determining 1) if the decision includes >1 medically reasonable option; 2) if one option has a favorable medical benefit-burden ratio compared to other options; and 3) parents' preferences regarding the options; then 4) calibrating the SDM approach based on other relevant decision characteristics. METHODS We videotaped a purposive sample of pediatric inpatient and outpatient encounters at a single US children's hospital. Clinicians from 7 clinical services (craniofacial, neonatology, oncology, pulmonary, pediatric intensive care, hospital medicine, and sports medicine) were eligible. English-speaking parents of children who participated in inpatient family care conferences or outpatient problem-oriented encounters with participating clinicians were eligible. We conducted individual postencounter interviews with clinician and parent participants utilizing video-stimulated recall to facilitate reflection of decision-making that occurred during the encounter. We utilized direct content analysis with open coding of interview transcripts to determine the salience of the 4-step SDM process and identify themes that confirmed, refuted, or modified this process. RESULTS We videotaped 30 encounters and conducted 53 interviews. We found that clinicians' and parents' experiences of decision-making confirmed each SDM step. However, there was variation in the interpretation of each step and a need for flexibility in implementing the process depending on specific decisional contexts. CONCLUSIONS The 4-step SDM process for pediatrics appears to be salient and may benefit from further guidance about the interpretation of each step and contextual factors that support a modified approach.
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Affiliation(s)
- Douglas J Opel
- Division of Bioethics and Palliative and Division of General Pediatrics, Department of Pediatrics, University of Washington School of Medicine and Treuman Katz Center for Pediatric Bioethics, Seattle Children's Research Institute (DJ Opel), Seattle, Wash.
| | - Holly Hoa Vo
- Division of Pulmonary and Sleep Medicine and Division of Bioethics and Palliative Care, Department of Pediatrics, University of Washington School of Medicine and Treuman Katz Center for Pediatric Bioethics, Seattle Children's Research Institute (HH Vo and BS Wilfond), Seattle, Wash
| | - Nicolas Dundas
- Treuman Katz Center for Pediatric Bioethics, Seattle Children's Research Institute (N Dundas, H Spielvogle, and A Mercer), Seattle, Wash
| | - Heather Spielvogle
- Treuman Katz Center for Pediatric Bioethics, Seattle Children's Research Institute (N Dundas, H Spielvogle, and A Mercer), Seattle, Wash
| | - Amanda Mercer
- Treuman Katz Center for Pediatric Bioethics, Seattle Children's Research Institute (N Dundas, H Spielvogle, and A Mercer), Seattle, Wash
| | - Benjamin S Wilfond
- Division of Pulmonary and Sleep Medicine and Division of Bioethics and Palliative Care, Department of Pediatrics, University of Washington School of Medicine and Treuman Katz Center for Pediatric Bioethics, Seattle Children's Research Institute (HH Vo and BS Wilfond), Seattle, Wash
| | - Jonna Clark
- Division of Critical Care Medicine and Division of Bioethics and Palliative Care, Department of Pediatrics, University of Washington School of Medicine and Treuman Katz Center for Pediatric Bioethics, Seattle Children's Research Institute (J Clark), Seattle, Wash
| | - Carrie L Heike
- Division of Craniofacial Medicine, Department of Pediatrics, University of Washington School of Medicine and Center for Clinical and Translational Research, Seattle Children's Research Institute (CL Heike), Seattle, Wash
| | - Elliott M Weiss
- Division of Neonatology and Division of Bioethics and Palliative Care, Department of Pediatrics, University of Washington School of Medicine and Treuman Katz Center for Pediatric Bioethics (EM Weiss), Seattle, Wash
| | - Mersine A Bryan
- Division of Hospital Medicine, Department of Pediatrics, University of Washington School of Medicine and Center for Clinical and Translational Research, Seattle Children's Research Institute (MA Bryan), Seattle, Wash
| | - Seema K Shah
- Department of Pediatrics, Northwestern University Feinberg School of Medicine; Bioethics Program, Lurie Children's Hospital (SK Shah), Chicago, Ill
| | - Carolyn A McCarty
- Division of General Pediatrics, Department of Pediatrics, University of Washington School of Medicine and Center for Child Health, Behavior, and Development, Seattle Children's Research Institute (CA McCarty), Seattle, Wash
| | - Jeffrey D Robinson
- Department of Communication, Portland State University (JD Robinson), Portland, Ore
| | - Jennifer Blumenthal-Barby
- Center for Medical Ethics and Health Policy, Baylor College of Medicine (J Blumenthal-Barby), Houston, Tex
| | - Jon Tilburt
- Division of General Internal Medicine, Department of Internal Medicine, Mayo Clinic (J Tilburt), Scottsdale, Ariz
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22
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Ryan GW, Askelson NM, Woodworth KR, Lindley MC, Gedlinske A, Parker AM, Gidengil CA, Petersen CA, Scherer AM. Unvaccinated Adolescents' COVID-19 Vaccine Intentions: Implications for Public Health Messaging. J Adolesc Health 2023; 73:679-685. [PMID: 37395695 PMCID: PMC10529916 DOI: 10.1016/j.jadohealth.2023.05.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2022] [Revised: 04/20/2023] [Accepted: 05/22/2023] [Indexed: 07/04/2023]
Abstract
PURPOSE COVID-19 vaccine uptake remains low for US adolescents and contributes to excess morbidity and mortality. Most research has assessed parental intention to vaccinate their children. We explored differences between vaccine-acceptant and vaccine-hesitant unvaccinated US adolescents using national survey data. METHODS A nonprobability, quota-based sample of adolescents, aged 13-17 years, was recruited through an online survey panel in April 2021. One thousand nine hundred twenty seven adolescents were screened for participation and the final sample included 985 responses. We assessed responses from unvaccinated adolescents (n = 831). Our primary measure was COVID-19 vaccination intent ("vaccine-acceptant" defined as "definitely will" get a COVID-19 vaccine and any other response classified as "vaccine-hesitant") and secondary measures included reasons for intending or not intending to get vaccinated and trusted sources of COVID-19 vaccine information. We calculated descriptive statistics and chi-square tests to explore differences between vaccine-acceptant and vaccine-hesitant adolescents. RESULTS Most (n = 831; 70.9%) adolescents were hesitant, with more hesitancy observed among adolescents with low levels of concern about COVID-19 and high levels of concern about side effects of COVID-19 vaccination. Among vaccine-hesitant adolescents, reasons for not intending to get vaccinated included waiting for safety data and having parents who would make the vaccination decision. Vaccine-hesitant adolescents had a lower number of trusted information sources than vaccine-acceptant adolescents. DISCUSSION Differences identified between vaccine-acceptant and vaccine-hesitant adolescents can inform message content and dissemination. Messages should include accurate, age-appropriate information about side effects and risks of COVID-19 infection. Prioritizing dissemination of these messages through family members, state and local government officials, and healthcare providers may be most effective.
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Affiliation(s)
- Grace W Ryan
- Division of Preventive and Behavioral Medicine, Department of Population and Quantitative Health Sciences, University of Massachusetts Chan Medical School, Worcester, Massachusetts.
| | - Natoshia M Askelson
- Department of Community and Behavioral Health, University of Iowa, Iowa City, Iowa
| | | | | | - Amber Gedlinske
- Department of Internal Medicine, University of Iowa, Iowa City, Iowa
| | | | - Courtney A Gidengil
- RAND Corporation, Boston, Massachusetts; Division of Infectious Diseases, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Christine A Petersen
- Department of Internal Medicine, University of Iowa, Iowa City, Iowa; Department of Epidemiology, University of Iowa, Iowa City, Iowa
| | - Aaron M Scherer
- Department of Internal Medicine, University of Iowa, Iowa City, Iowa
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23
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Salhi C, Beatriz E, Berrigan J, Azrael D, Houston A, Runyan C, Barber C, Betz M, Miller M. "Your son needs help … and we're gonna help him": A qualitative study of the experiences of gun-owning caregivers of adolescents receiving lethal means counseling in the emergency department. Soc Sci Med 2023; 335:116218. [PMID: 37738913 DOI: 10.1016/j.socscimed.2023.116218] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2023] [Revised: 07/17/2023] [Accepted: 09/01/2023] [Indexed: 09/24/2023]
Abstract
Suicide attempts in adolescents are often transient and unpredictable, making preventative approaches crucial in reducing suicide deaths. One important approach is lethal means counseling (LMC), in which clinicians counsel caregivers to reduce access to methods used in suicide, specifically firearms and medications. Research on LMC has increasingly encouraged the use of the shared decision-making (SDM) model, which emphasizes information exchange, collaborative deliberation, and joint planning between caregivers and clinicians. We examine caregivers' experiences with LMC, using the SDM model as our analytic framework. We conducted qualitative interviews with 21 firearm-owning caregivers of adolescents who came to emergency departments (EDs) in Colorado for a behavioral health complaint. The implementation of LMC at these institutions had three central components: training for clinicians, materials (e.g., lockboxes and pamphlets) to support LMC, and the protocolization of LMC at the institution. Our semi-structured, hour-long interviews examined participants' reflections on and reactions to LMC provided in the ED and how that related to changes in their understanding of their medication and gun storage practices. We analyzed interviews using a phenomenological approach, focusing on experiences with LMC and informed by the tenets of the SDM model. Our analysis revealed that caregivers were receptive to the idea of LMC in the pediatric emergency care setting. Caregivers' engagement in LMC was reinforced by experiences with clinicians who sought to understand the circumstances of their household, shared the motivation behind LMC, and facilitated conversation around a shared concern for the child's safety. In contrast, counseling delivered mechanically and without considering the household context was tied to caregivers' confusion and alienation, both for LMC and their consideration of changes to home storage practices. These findings provide insight into adolescent caregivers' experiences with LMC implemented in EDs and how LMC may best be approached.
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Affiliation(s)
- Carmel Salhi
- Department of Health Sciences, Northeastern University, Boston, MA, USA; Institute of Health Equity and Social Justice Research, Northeastern University, Boston, USA.
| | | | - John Berrigan
- University of Kansas School of Medicine, University of Kansas Medical Center, Kansas City, KS, USA; Harvard Injury Control Research Center, Harvard Chan School of Public Health, Boston, MA, USA.
| | - Deb Azrael
- Harvard Injury Control Research Center, Harvard Chan School of Public Health, Boston, MA, USA.
| | - Ashley Houston
- Institute of Health Equity and Social Justice Research, Northeastern University, Boston, USA.
| | - Carol Runyan
- Department of Epidemiology, Colorado School of Public Health, Aurora, CO, USA.
| | - Catherine Barber
- Harvard Injury Control Research Center, Harvard Chan School of Public Health, Boston, MA, USA.
| | - Marian Betz
- Injury and Violence Prevention Center, Colorado School of Public Health, Aurora, CO, USA; Department of Emergency Medicine, University of Colorado School of Medicine, Aurora, CO, USA.
| | - Matthew Miller
- Department of Health Sciences, Northeastern University, Boston, MA, USA; Harvard Injury Control Research Center, Harvard Chan School of Public Health, Boston, MA, USA.
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24
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Taub S, Macauley R. Responding to Parental Requests for Nondisclosure to Patients of Diagnostic and Prognostic Information in the Setting of Serious Disease. Pediatrics 2023; 152:e2023063754. [PMID: 37743818 DOI: 10.1542/peds.2023-063754] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/27/2023] [Indexed: 09/26/2023] Open
Abstract
Learning that one's child is seriously ill can be devastating, requiring families to decide when and how to share information about diagnosis and prognosis with their child. In most cases, this disclosure is made thoughtfully and collaboratively with the medical team. Some parents, however, may be concerned that disclosure will take away their child's hope, cause emotional pain, or exceed the child's capacity for understanding. Faced with competing obligations of truth-telling to their patient and respect for parental wishes, pediatricians may be unsure how to proceed. This clinical report examines ethical duties and legal considerations, providing practical and culturally sensitive case-based guidance for clinicians to approach parental requests for nondisclosure of diagnostic or prognostic information.
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Affiliation(s)
- Sara Taub
- Division of General Pediatrics, Department of Pediatrics
- Division of Palliative Care, Department of Pediatrics, Oregon Health & Science University, Portland, Oregon
| | - Robert Macauley
- Division of Palliative Care, Department of Pediatrics, Oregon Health & Science University, Portland, Oregon
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25
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Diener BL, Huertero F, Stables-Carney T, Hoelzer M, Kier C. A new era in cystic fibrosis care: always changing and adapting. Curr Opin Pediatr 2023; 35:603-610. [PMID: 37594368 DOI: 10.1097/mop.0000000000001286] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/19/2023]
Abstract
PURPOSE OF REVIEW This review focuses on sharing the current and changing cystic fibrosis (CF) care model. This includes changes in CF care as a chronic disease with availability of new revolutionary, highly effective therapies as well as incorporation of shared decision-making, coproduction of care, quality improvement, telemedicine, and remote patient monitoring. RECENT FINDINGS Changes in the CF management, the CF patient population, and CF care team are described as well as how CF care has adapted to these changes. SUMMARY CF is a chronic, multisystem disease requiring a large specialized multidisciplinary care team for effective treatment. With improvements in CF care and new treatments, people with CF are living longer and healthier lives. As new issues arise, the CF team needs to adapt. This was highlighted by the introduction of highly effective cystic fibrosis transmembrane conductance regulator modulator therapy, which targets the cellular defect in CF, the COVID-19 pandemic, which lead to the incorporation of telehealth and remote patient monitoring into the CF care model, and the partnering with people with CF and families through shared decision-making and coproduction.
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Affiliation(s)
| | - Fredy Huertero
- Department of Pediatrics, Stony Brook Children's Hospital, Renaissance School of Medicine at Stony Brook University
| | | | - Maureen Hoelzer
- Department of Medicine, Stony Brook University Hospital, Stony Brook, New York, USA
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26
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Ahlqvist-Björkroth S, Thernström Blomqvist Y, Nyberg J, Normann E, Axelin A. Improving NICU staff decision-making with parents in medical rounds: a pilot study of reflective group dialogue intervention. Front Pediatr 2023; 11:1249345. [PMID: 37772036 PMCID: PMC10523391 DOI: 10.3389/fped.2023.1249345] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2023] [Accepted: 08/28/2023] [Indexed: 09/30/2023] Open
Abstract
Introduction The communication skills of healthcare professionals play a crucial role in successful shared decision-making with parents in neonatal intensive care. Improving communication skills can be achieved through practice and reflection on personal experiences after authentic interaction events with parents. The process of reflection typically involves three phases: description, reflection, and critical reflection. In this study, our aim was to explore the acceptability of the Reflective Group Dialogue intervention and its effectiveness in supporting the reflective process. Methods This qualitative pilot study was conducted in the neonatal intensive care unit at Uppsala University Children's Hospital, Sweden. The sample consisted of nine medical rounds with seven families, five neonatologists, seven registered nurses, and five assistant nurses. Purposive sampling was used to collect the data. The intervention comprised four elements: (1) before the intervention, a recorded presentation on shared decision-making was given to the entire unit staff, (2) an observation of a normal medical round discussion with parents, (3) an interview with parents about their experience after the same round, and (4) a reflective discussion with the participating health care professionals after the round. The parent interviews and reflective discussions were audio-recorded and transcribed verbatim. They were analyzed using thematic analysis as a theoretical strategy. Results Both parents and staff widely accepted the intervention and found it beneficial. We identified four discussions that remained in the descriptive phase of the reflection process, four that reached the reflective phase, and one that reached the critical reflection phase. The descriptive discussions were characterized by using a single perspective to reflect, often based on personal opinions. The reflective discussions included analyzing interaction sequences from both staff and parent perspectives and were primarily based on actual observations of communication during medical rounds. The critical discussion led to a new awareness of current practices concerning parental involvement in decision-making. These discussions also utilized "what-if" thinking to evaluate potential new practices and their pros and cons. Conclusions The intervention seems promising as it was perceived as beneficial by the recipients and facilitated reflection in most cases. However, to enhance the feasibility of the intervention, some improvements are discussed.
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Affiliation(s)
- Sari Ahlqvist-Björkroth
- Department of Psychology and Speech-Language Pathology, University of Turku, Turku, Finland
- Department of Clinical Medicine, University of Turku, Turku, Finland
| | | | - Jenni Nyberg
- Department of Psychology and Speech-Language Pathology, University of Turku, Turku, Finland
| | - Erik Normann
- Department of Women’s and Children’s Health, Uppsala University, Uppsala, Sweden
| | - Anna Axelin
- Department of Women’s and Children’s Health, Uppsala University, Uppsala, Sweden
- Departmentof Nursing Science, University of Turku, Turku, Finland
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27
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Waxmonsky JG, Waschbusch DA, Groff D, Jairath B, Sekhar DL, Sibley MH, Logan JM, Fogel B. Effects of a Primary Care-Based Engagement Intervention for Improving Use of ADHD Treatments. J Pediatr Health Care 2023; 37:537-547. [PMID: 37227324 DOI: 10.1016/j.pedhc.2023.04.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2023] [Accepted: 04/30/2023] [Indexed: 05/26/2023]
Abstract
INTRODUCTION Uptake of attention deficit hyperactivity disorder (ADHD) treatments is low in primary care. A quasi-experimental study assessed the impact of a primary care-based engagement intervention to improve ADHD treatment use. METHOD Families of children with ADHD from four pediatric clinics were invited to participate in a two-stage intervention. The first step was an assessment battery to assess functioning and identify goals, followed by an in-office engagement session run by primary care staff. RESULTS Of the 636 invited families, 184 (28.9%) completed ratings, with 95 (51%) families completing the engagement session. ADHD office visits varied based on the number of steps completed (0-2). ADHD prescriptions decreased over time in families completing neither step but increased for children previously unmedicated whose parents completed either step. Families completing both steps had the highest rates of nonmedication ADHD treatments. DISCUSSION A brief two-step engagement intervention was associated with increased uptake of ADHD treatments.
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28
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Terrizzi BF, Lambert AS, Conard LAE, Vaughn LM, Lipstein EL. Providers' Perspectives on Decision-Making About Care for Transgender Youth. Transgend Health 2023; 8:337-343. [PMID: 37525837 PMCID: PMC10387150 DOI: 10.1089/trgh.2021.0120] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Background Transgender and gender-diverse (TGD) youth face health care decisions that are complicated by both social and medical aspects of gender care. Little is known about how providers support decision-making in this context or the gaps they perceive in decision support. Objective To explore health care providers' perspectives on the decision-making processes in youth gender care. Methods We interviewed health care providers (n=17) caring for TGD youth and asked about the nature of families' decision-making, providers' role in this process, and potential improvements to existing support systems. Two independent coders coded all responses which were analyzed using thematic analysis. Results From providers' perspectives, they serve as "guides" to families through a challenging decision-making process. Youth arrive educated and eager to begin treatment, but caregivers are more hesitant. Providers lack data to address parents' concerns, and struggle to support families through interpersonal conflict. All providers recognized a need to improve decision support for families. Conclusions Providers described decision-making in this context as a multistep process where interpersonal conflict and limited data slow progress. Practice Implications There is ample opportunity to leverage insights from adult and pediatric medical decision-making research to improve decision support for providers, TGD youth, and families.
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Affiliation(s)
- Brandon F. Terrizzi
- Division of General & Community Pediatrics, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| | - Amy Sue Lambert
- Clinical Psychology, Gallaudet University, Washington, District of Columbia, USA
| | - Lee Ann E. Conard
- Adolescent Medicine, Transgender Health Clinic, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
| | - Lisa M. Vaughn
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
- Pediatric Emergency Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| | - Ellen L. Lipstein
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
- James M. Anderson Center for Health Systems Excellence, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
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29
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Tanious MK, Barnett N, Bisbee C, McCoy NC, Wolf BJ, Arenth J. Relationship Between Palliative Care Consults and Outcomes of Pediatric Surgical Patients During Terminal Admissions. J Palliat Med 2023; 26:1074-1080. [PMID: 36827088 DOI: 10.1089/jpm.2022.0610] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/25/2023] Open
Abstract
Background: Pediatric patients often undergo surgery during terminal admissions. However, the involvement and timing of palliative care consults in caring for these patients has not been readily described. Objective: To describe the presence and timing of palliative care consults for pediatric patients who undergo surgical procedures during terminal admissions. Design: Retrospective cohort study using data from the electronic health record. Setting and Participants: Pediatric patients who underwent at least one surgical procedure during a terminal admission at an urban, quaternary hospital in the United States from January 1, 2016 to December 31, 2021. Main Outcomes and Measures: Patients' medical, surgical, and admission-level characteristics were abstracted. Associations were evaluated between these characteristics and the occurrence and timing of a palliative care consult relative to surgery and death. Results: Of 134 patients, 84% received a palliative care consult during their terminal admission. Approximately 36% of consults occurred before surgery, and 12% were within one day of death. Children without a palliative care consult were more likely than children with a consult to die during surgery (19.1% vs. 2.7%, p = 0.02), have surgery within 24 hours of death (52.4% vs. 15.9%, p < 0.001), and undergo a full resuscitation attempt (47.6% vs. 12.4%, p = 0.002). Receipt of a palliative care consultation did not differ by patient sex, reported race and ethnicity, language, insurance, or income level. Conclusions and Relevance: Palliative care consults support high-quality end-of-life care for children and impact perioperative outcomes, including intensity of surgical care and resuscitation in the final hours of life.
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Affiliation(s)
- Mariah K Tanious
- Department of Anesthesia and Perioperative Medicine, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Natalie Barnett
- Department of Anesthesia and Perioperative Medicine, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Cora Bisbee
- Medical University of South Carolina College of Medicine, Charleston, South Carolina, USA
| | - Nicole C McCoy
- Department of Anesthesia and Perioperative Medicine, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Bethany J Wolf
- Department of Anesthesia and Perioperative Medicine, Medical University of South Carolina, Charleston, South Carolina, USA
- Department of Public Health Sciences, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Joshua Arenth
- Department of Pediatrics, Medical University of South Carolina, Charleston, South Carolina, USA
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30
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Toupin-April K, Gaboury I, Proulx L, Huber AM, Duffy CM, Morgan EM, Li LC, Stringer E, Connelly M, Weiss JE, Gibbon M, Sachs H, Sivakumar A, Sirois A, Sirotich E, Trehan N, Abrahams N, Cohen JS, Cavallo S, Hindi TE, Ragusa M, Légaré F, Brinkman WB, Fortin PR, Décary S, Lee R, Gmuca S, Paterson G, Tugwell P, Stinson JN. "I'd like more options!": Interviews to explore young people and family decision-making needs for pain management in juvenile idiopathic arthritis. Pediatr Rheumatol Online J 2023; 21:74. [PMID: 37491246 PMCID: PMC10369758 DOI: 10.1186/s12969-023-00849-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2023] [Accepted: 06/14/2023] [Indexed: 07/27/2023] Open
Abstract
BACKGROUND Juvenile idiopathic arthritis (JIA) is a common pediatric rheumatic condition and is associated with symptoms such as joint pain that can negatively impact health-related quality of life. To effectively manage pain in JIA, young people, their families, and health care providers (HCPs) should be supported to discuss pain management options and make a shared decision. However, pain is often under-recognized, and pain management discussions are not optimal. No studies have explored decision-making needs for pain management in JIA using a shared decision making (SDM) model. We sought to explore families' decision-making needs with respect to pain management among young people with JIA, parents/caregivers, and HCPs. METHODS We conducted semi-structured virtual or face-to-face individual interviews with young people with JIA 8-18 years of age, parents/caregivers and HCPs using a qualitative descriptive study design. We recruited participants online across Canada and the United States, from a hospital and from a quality improvement network. We used interview guides based on the Ottawa Decision Support Framework to assess decision-making needs. We audiotaped, transcribed verbatim and analyzed interviews using thematic analysis. RESULTS A total of 12 young people (n = 6 children and n = 6 adolescents), 13 parents/caregivers and 11 HCPs participated in interviews. Pediatric HCPs were comprised of rheumatologists (n = 4), physical therapists (n = 3), rheumatology nurses (n = 2) and occupational therapists (n = 2). The following themes were identified: (1) need to assess pain in an accurate manner; (2) need to address pain in pediatric rheumatology consultations; (3) need for information on pain management options, especially nonpharmacological approaches; (4) importance of effectiveness, safety and ease of use of treatments; (5) need to discuss young people/families' values and preferences for pain management options; and the (6) need for decision support. Themes were similar for young people, parents/caregivers and HCPs, although their respective importance varied. CONCLUSIONS Findings suggest a need for evidence-based information and communication about pain management options, which would be addressed by decision support interventions and HCP training in pain and SDM. Work is underway to develop such interventions and implement them into practice to improve pain management in JIA and in turn lead to better health outcomes.
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Affiliation(s)
- Karine Toupin-April
- School of Rehabilitation Sciences, Faculty of Health Sciences, University of Ottawa, Ottawa, ON Canada
- Department of Pediatrics, Faculty of Medicine, University of Ottawa, Ottawa, ON Canada
- Children’s Hospital of Eastern Ontario Research Institute, Ottawa, ON Canada
- Institut du Savoir Montfort, Ottawa, ON Canada
| | - Isabelle Gaboury
- Department of Family and Emergency Medicine, Faculty of Medicine and Health Sciences, Université de Sherbrooke, Longueuil, Québec Canada
| | - Laurie Proulx
- Canadian Arthritis Patient Alliance, Ottawa, ON Canada
| | - Adam M. Huber
- Division of Rheumatology, IWK Health Centre, Halifax, NS Canada
- Department of Pediatrics, Dalhousie University, Halifax, NS Canada
| | - Ciarán M. Duffy
- Children’s Hospital of Eastern Ontario Research Institute, Ottawa, ON Canada
- Department of Pediatrics, Faculty of Medicine, Ottawa, ON Canada
| | - Esi M. Morgan
- Division of Rheumatology, Seattle Children’s Hospital, Seattle, Washington USA
- Department of Pediatrics, University of Washington School of Medicine, Seattle, WA USA
| | - Linda C. Li
- Department of Physical Therapy, Faculty of Medicine, University of British Columbia, Vancouver, BC Canada
- Arthritis Research Canada, Vancouver, BC Canada
| | - Elizabeth Stringer
- Division of Rheumatology, IWK Health Centre, Halifax, NS Canada
- Department of Pediatrics, Dalhousie University, Halifax, NS Canada
| | - Mark Connelly
- Department of Pediatrics, Children’s Mercy Kansas City, Kansas City, MO USA
| | - Jennifer E. Weiss
- Division of Rheumatology, Hackensack University Medical Center, Hackensack Meridian School of Medicine, Hackensack, NJ USA
| | - Michele Gibbon
- Children’s Hospital of Eastern Ontario Research Institute, Ottawa, ON Canada
| | - Hannah Sachs
- Public Health Agency of Canada, Ottawa, ON Canada
| | - Aditi Sivakumar
- Children’s Hospital of Eastern Ontario Research Institute, Ottawa, ON Canada
- Queen’s University, ON Ottawa, Canada
| | | | - Emily Sirotich
- Canadian Arthritis Patient Alliance, New Haven, CT USA
- Yale University School of Medicine, New Haven, CT USA
| | | | - Naomi Abrahams
- Faculty of Social Sciences, University of Ottawa, Ottawa, ON Canada
| | - Janice S. Cohen
- Children’s Hospital of Eastern Ontario Research Institute, Ottawa, ON Canada
- Behavioural Neurosciences and Consultation Liaison Team, Mental Health, Children’s Hospital of Eastern Ontario, Ottawa, ON Canada
- School of Psychology, Faculty of Social Sciences, University of Ottawa, ON Ottawa, Canada
| | - Sabrina Cavallo
- School of Rehabilitation, Faculty of Medicine, Université de Montréal, Montréal, QC Canada
- Centre for Interdisciplinary Research in Rehabilitation of Greater Montreal, Montréal, QC Canada
- Research Centre of the Sainte-Justine University Hospital, Montreal, QC Canada
| | - Tania El Hindi
- Statistics Canada, Government of Canada, Ottawa, ON Canada
| | - Marco Ragusa
- The Ottawa Hospital, University of Ottawa, Ottawa, ON Canada
| | - France Légaré
- Department of Family and Emergency Medicine, Université Laval, Québec City, QC Canada
- VITAM, Centre de recherche en santé durable, Centre intégré universitaire de santé et services sociaux de la Capitale Nationale, Québec City, QC Canada
| | - William B. Brinkman
- Cincinnati Children’s Hospital Medical Center, OH Cincinnati, USA
- College of Medicine, Department of Pediatrics, University of Cincinnati, Cincinnati, OH United States
| | - Paul R. Fortin
- Université Laval, QC, Canada
- CHU de Québec, Québec City, QC Canada
| | - Simon Décary
- School of Rehabilitation, Faculty of Medicine and Health Sciences, Université de Sherbrooke, Sherbrooke, QC Canada
- Research Center of the Centre Hospitalier de l’Université de Sherbrooke, Sherbrooke, QC Canada
| | - Rebecca Lee
- Centre for Epidemiology Versus Arthritis, Centre for Musculoskeletal Research, Division of Musculoskeletal and Dermatological Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester Academic Health Science Centre, Manchester, UK
- National Institute for Health Research Biomedical Research Centre, Manchester University Hospital NHS Trust, Manchester, UK
- Manchester Centre for Health Psychology, Division of Psychology and Mental Health, University of Manchester, Manchester, UK
| | - Sabrina Gmuca
- Division of Rheumatology, Children’s Hospital of Philadelphia, Philadelphia, PA USA
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA USA
| | - Gail Paterson
- Arthritis Rehabilitation and Education Program, Arthritis Society Canada, Ottawa, ON Canada
| | - Peter Tugwell
- School of Epidemiology and Community Medicine, Department of Medicine, University of Ottawa, Ottawa, ON Canada
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON Canada
- WHO Collaborating Centre for Knowledge Translation and Health Technology Assessment in Health Equity, Bruyère Research Institute, Ottawa, ON Canada
| | - Jennifer N. Stinson
- Child Health Evaluative Sciences, Research Institute, The Hospital for Sick Children, University of Toronto, Toronto, ON Canada
- Lawrence S. Bloomberg, Faculty of Nursing, University of Toronto, Toronto, ON Canada
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Foster A, Chan JM, Wine E, El-Matary W, Carroll MW, Kroeker KI, deBruyn JC, Seow CH, Lawrence S, Evans K, Kluthe C, Sharifi N, Pears C, Nicol S, Olayinka L, Fu N, Huynh HQ, Bressler B, Bernstein CN, Jacobson K. Transition Readiness in Youth with Inflammatory Bowel Disease. J Pediatr 2023; 258:113403. [PMID: 37019332 DOI: 10.1016/j.jpeds.2023.113403] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2022] [Revised: 03/20/2023] [Accepted: 03/27/2023] [Indexed: 04/07/2023]
Abstract
OBJECTIVES To examine readiness of adolescents and young adults (AYAs) with inflammatory bowel disease (IBD) to transition to adult care. STUDY DESIGN A cross-sectional multicenter study evaluating transition readiness in individuals with IBD 16-19 years old prospectively recruited from 8 Canadian IBD centers using the validated ON Taking Responsibility for Adolescent to Adult Care (ON TRAC) questionnaire. Secondary aims included (1) screening for depression and anxiety using the 8-item Personal Health Questionnaire Depression Scale and The Screen for Child Anxiety Related Emotional Disorders questionnaires, respectively; (2) evaluating the association between depression and anxiety with readiness and disease activity; and (3) subjectively evaluating AYA readiness based on physician and parent assessments. RESULTS In total, 186 participants (139 adolescent, 47 young adult) were enrolled, mean age 17.4 years (SD, 0.87). ON TRAC scores determined that 26.6% of AYAs at pediatric and 40.4% at adult centers reached the threshold of readiness. On multivariable linear regression analysis age was positively (P = .001) and disease remission negatively (P = .03) associated with ON TRAC scores. No statistically significant differences were determined across centers. A significant percentage of AYAs reported moderate-to-severe depression (21.7%) and generalized anxiety (36%); however, neither were significantly associated with ON TRAC scores. Notably, physician and parental assessment of AYA readiness correlated poorly with ON TRAC scores (⍴ = 0.11, ⍴ = 0.24, respectively). CONCLUSIONS Assessment of transition readiness in AYAs with IBD highlighted that a large proportion do not have adequate knowledge or behavior skills needed for transition to adult care. This study infers that readiness assessment tools are essential during transition to identify deficits in knowledge and behavior skills that could be specifically targeted by the youth, caregivers, and multidisciplinary team.
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Affiliation(s)
- Alice Foster
- Department of Pediatrics, Division of Gastroenterology, Hepatology and Nutrition, Faculty of Medicine, British Columbia Children's Hospital and British Columbia Children Hospital Research Institute, Vancouver, British Columbia, Canada
| | - Justin M Chan
- Department of Pediatrics, Division of Gastroenterology, Hepatology and Nutrition, Faculty of Medicine, British Columbia Children's Hospital and British Columbia Children Hospital Research Institute, Vancouver, British Columbia, Canada
| | - Eytan Wine
- Department of Pediatrics, Division of Gastroenterology, Stollery Children's Hospital, University of Alberta, Edmonton, Alberta, Canada
| | - Wael El-Matary
- Department of Pediatrics, Division of Gastroenterology, Winnipeg Children's Hospital, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Matthew W Carroll
- Department of Pediatrics, Division of Gastroenterology, Stollery Children's Hospital, University of Alberta, Edmonton, Alberta, Canada
| | - Karen I Kroeker
- Division of Gastroenterology, Department of Medicine, University of Alberta, Edmonton, Alberta, Canada
| | - Jennifer C deBruyn
- Departments of Pediatrics and Community Health Sciences, Division of Gastroenterology, Alberta Children's Hospital, University of Calgary, Calgary, Alberta, Canada
| | - Cynthia H Seow
- Division of Gastroenterology and Hepatology, Departments of Medicine and Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
| | - Sally Lawrence
- Department of Pediatrics, Division of Gastroenterology, Hepatology and Nutrition, Faculty of Medicine, British Columbia Children's Hospital and British Columbia Children Hospital Research Institute, Vancouver, British Columbia, Canada
| | - Kathy Evans
- Department of Pediatrics, Division of Gastroenterology, Hepatology and Nutrition, Faculty of Medicine, British Columbia Children's Hospital and British Columbia Children Hospital Research Institute, Vancouver, British Columbia, Canada
| | - Cheryl Kluthe
- Department of Pediatrics, Division of Gastroenterology, Stollery Children's Hospital, University of Alberta, Edmonton, Alberta, Canada
| | - Nastaran Sharifi
- Division of Gastroenterology and Hepatology, Departments of Medicine and Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
| | | | - Simone Nicol
- Division of Pediatric Gastroenterology, Hepatology and Nutrition, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - Lily Olayinka
- Division of Gastroenterology, Department of Medicine, University of Alberta, Edmonton, Alberta, Canada
| | - Nancy Fu
- Division of Gastroenterology, Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Hien Q Huynh
- Department of Pediatrics, Division of Gastroenterology, Stollery Children's Hospital, University of Alberta, Edmonton, Alberta, Canada
| | - Brian Bressler
- IBD Center of BC, Vancouver, British Columbia, Canada; Division of Gastroenterology, Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Charles N Bernstein
- University of Manitoba Inflammatory Bowel Disease Clinical and Research Center and Department of Internal Medicine, Max Rady College of Medicine, Rady Faculty of Health sciences, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Kevan Jacobson
- Department of Pediatrics, Division of Gastroenterology, Hepatology and Nutrition, Faculty of Medicine, British Columbia Children's Hospital and British Columbia Children Hospital Research Institute, Vancouver, British Columbia, Canada; Department of Cellular and Physiological Sciences, University of British Columbia, Vancouver, British Columbia, Canada.
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Wilkin T, Stott A, Lin JL, Pate J, McEwen A, Verhagen A, Turbitt E. Free Online Decision Tools to Support Parents Making Decisions About Their Children's Chronic Health Condition: An Environmental Scan. Acad Pediatr 2023; 23:874-883. [PMID: 36775123 PMCID: PMC11047007 DOI: 10.1016/j.acap.2023.02.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2022] [Revised: 01/31/2023] [Accepted: 02/04/2023] [Indexed: 02/12/2023]
Abstract
BACKGROUND Medical decisions parents make on their children's behalf can be challenging. Free online decision support tools are created to help parents faced with these decisions. OBJECTIVE We used an environmental scan to identify free, online tools that support parents in making decisions about their children's chronic health condition. We described the tools and assessed their potential to harm, content, development process, readability, and whether their use changed decision makers' knowledge and alignment of their preferences with their final decision. DATA SOURCES AND ELIGIBILITY Decision aid repositories, Google searches, and key informants identified decision support tools. Eligible tools were freely available online and for parents of children with chronic health conditions. APPRAISAL METHODS Two reviewers independently assessed the tools' quality based on the International Patient Decision Aid Standards (IPDAS). Tool readability was assessed using the Flesch Reading Ease test. RESULTS From 21 free, online decision support tools, 14 (67%) provided sufficient detail for making a specific decision (IPDAS qualifying criteria). None sufficiently met IPDAS certification criteria necessary to reduce the possibility of patient harms when using the tool. Three (14%) were fairly easy or easy to read. Of those evaluated by developers (n = 6), 2 improved knowledge and 4 improved alignment of preferences with the available options. LIMITATIONS Google searches and key informant sources are not replicable. CONCLUSIONS Free, online decision support tools for parents of children with chronic health conditions are of variable quality, most are difficult to read, and there is limited evidence their use achieves intended outcomes. REGISTRATION NUMBER Registered with Open Science Framework 20 July 2021(AEST) osf.io/b94yj.
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Affiliation(s)
- Tessa Wilkin
- Discipline of Genetic Counselling, University of Technology Sydney (T Wilkin, A Stott, A McEwen, and E Turbitt), Ultimo, NSW, Australia
| | - Ami Stott
- Discipline of Genetic Counselling, University of Technology Sydney (T Wilkin, A Stott, A McEwen, and E Turbitt), Ultimo, NSW, Australia
| | - Jody L Lin
- Department of Pediatrics, University of Utah Health (JL Lin), Salt Lake City, Utah
| | - Joshua Pate
- Discipline of Physiotherapy, University of Technology Sydney (J Pate and A Verhagen), Ultimo, NSW, Australia
| | - Alison McEwen
- Discipline of Genetic Counselling, University of Technology Sydney (T Wilkin, A Stott, A McEwen, and E Turbitt), Ultimo, NSW, Australia
| | - Arianne Verhagen
- Discipline of Physiotherapy, University of Technology Sydney (J Pate and A Verhagen), Ultimo, NSW, Australia
| | - Erin Turbitt
- Discipline of Genetic Counselling, University of Technology Sydney (T Wilkin, A Stott, A McEwen, and E Turbitt), Ultimo, NSW, Australia.
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Abstract
Seeking children's assent has been put forward as a way to foster children's involvement in the healthcare decision-making process. However, the functions of the concept of assent within clinical care are manifold, and methods used to recognize children's capacities and promote their involvement in their care remain debated. We performed an instrumentalist concept analysis of assent, with 58 included articles. Final themes were jointly identified through a deliberative process. Two distinct perspectives of assent were predominant: as an affirmative agreement for a specific decision and as part of a continuous, interactive process of care. Differing standards were provided as to how and when to apply the concept of assent. The concept of dissent was largely omitted from conceptions of assent, especially in situations for which children's refusal would lead to severe health consequences. Ethical implications included fostering autonomy, reducing physical/psychological harm to the child, respecting the child as a human being, and fulfilling the universal rights of the child. There remain important gaps in the theory of assent and its desirable and possible practical implications. Practical standards are largely missing, and evidence supporting the claims made in the literature requires further investigation.
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Affiliation(s)
| | - Justine Fortin
- Pragmatic Health Ethics Research Unit, Institut de recherches cliniques de Montréal, Canada
| | - Eric Racine
- Pragmatic Health Ethics Research Unit, Institut de recherches cliniques de Montréal, Canada
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Binion KE, Rode AU, Nortey G, Miller AD, Misseri R, Kaefer M, Ross S, Preisser JS, Hu D, Chan KH. A multi-site pilot study of a parent-centered tool to promote shared decision-making in hypospadias care. J Pediatr Urol 2023; 19:290.e1-290.e10. [PMID: 36801199 PMCID: PMC10278576 DOI: 10.1016/j.jpurol.2023.01.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2022] [Revised: 12/14/2022] [Accepted: 01/30/2023] [Indexed: 02/10/2023]
Abstract
BACKGROUND Using a user-centered design approach, we conducted a two-site pilot study to evaluate a decision aid (DA) website, the Hypospadias Hub, for parents of hypospadias patients. OBJECTIVES The objectives were to assess the Hub's acceptability, remote usability, and feasibility of study procedures, and to evaluate its preliminary efficacy. METHODS From June 2021-February 2022, we recruited English-speaking parents (≥18 years old) of hypospadias patients (≤5 years) and delivered the Hub electronically ≤2 months before their hypospadias consultation. We collected website analytic data using an ad tracker plug-in. We inquired about treatment preference, hypospadias knowledge, and decisional conflict (Decisional Conflict Scale) at baseline, after viewing the Hub (pre-consultation), and post-consultation. We administered the Decision Aid Acceptability Questionnaire (DAAQ) and the Preparation for Decision-Making Scale (PrepDM) which assessed how well the Hub prepared parents for decision-making with the urologist. Post-consultation, we assessed participants' perception of involvement in decision-making with the Shared Decision-making Questionnaire (SDM-Q-9) and the Decision Regret Scale (DRS). A bivariate analysis compared participants' baseline and pre/post-consultation hypospadias knowledge, decisional conflict, and treatment preference. Using a thematic analysis, we analyzed our semi-structured interviews to uncover how the Hub impacted the consultation and what influenced participants' decisions. RESULTS Of 148 parents contacted, 134 were eligible and 65/134 (48.5%) enrolled: mean age 29.2, 96.9% female, 76.6% White (Extended Summary Figure). Pre/post-viewing the Hub, there was a statistically significant increase in hypospadias knowledge (54.3 vs. 75.6, p < 0.001) and decrease in decisional conflict (36.0 vs. 21.9, p < 0.001). Most participants (83.3%) thought Hub's length and amount of information (70.4%) was "about right", and 93.0% found most or everything was clear. Pre/post-consultation, there was a statistically significant decrease in decisional conflict (21.9 vs. 8.8, p < 0.001). PrepDM's mean score was 82.6/100 (SD = 14.1); SDM-Q-9's mean score was 82.5/100 (SD = 16.7). DCS's mean score was 25.0/100 (SD = 47.03). Each participant spent an average of 25.75 min reviewing the Hub. Based on thematic analysis, the Hub helped participants feel prepared for the consultation. DISCUSSION Participants engaged extensively with the Hub and demonstrated improved hypospadias knowledge and decision quality. They felt prepared for the consultation and perceived a high degree of involvement in decision-making. CONCLUSION As the first pilot test of a pediatric urology DA, the Hub was acceptable and study procedures were feasible. We plan to conduct a randomized controlled trial of the Hub versus usual care to test its efficacy to improve the quality of shared decision-making and reduce long-term decisional regret.
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Affiliation(s)
- Kelsey E Binion
- Department of Communication Studies, Indiana University Purdue University, Indianapolis, IN, USA.
| | - Akash Uday Rode
- Department of Human-Centered Computing, Luddy School of Informatics, Computing, and Engineering, Indiana University, Indianapolis, IN, USA.
| | - Gabrielle Nortey
- Department of Urology, University of North Carolina School of Medicine, Chapel Hill, NC, USA.
| | - Andrew D Miller
- Department of Human-Centered Computing, Luddy School of Informatics, Computing, and Engineering, Indiana University, Indianapolis, IN, USA.
| | - Rosalia Misseri
- Department of Urology, Indiana University School of Medicine, Indianapolis, IN, USA.
| | - Martin Kaefer
- Department of Urology, Indiana University School of Medicine, Indianapolis, IN, USA.
| | - Sherry Ross
- Department of Urology, University of North Carolina School of Medicine, Chapel Hill, NC, USA.
| | - John S Preisser
- Department of Biostatistics, University of North Carolina Gillings School of Global Public Health, Chapel Hill, NC, USA.
| | - Di Hu
- Department of Biostatistics, University of North Carolina Gillings School of Global Public Health, Chapel Hill, NC, USA.
| | - Katherine H Chan
- Department of Urology, University of North Carolina School of Medicine, Chapel Hill, NC, USA; Department of Pediatrics, University of North Carolina School of Medicine, Chapel Hill, NC, USA.
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Leon-Astudillo C, Okorie CUA, McCown MY, Dy FJ, Puranik S, Prero M, ElMallah MK, Treat L, Gross JE. ATS Core Curriculum 2022. Pediatric Pulmonary Medicine: Updates in pediatric neuromuscular disease. Pediatr Pulmonol 2023. [PMID: 37144867 DOI: 10.1002/ppul.26448] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2023] [Accepted: 04/23/2023] [Indexed: 05/06/2023]
Abstract
The American Thoracic Society Core Curriculum updates clinicians annually in pediatric pulmonary disease. This is a concise review of the Pediatric Pulmonary Medicine Core Curriculum presented at the 2022 American Thoracic Society International Conference. Neuromuscular diseases (NMD) comprise a variety of conditions that commonly affect the respiratory system and cause significant morbidity including dysphagia, chronic respiratory failure, and sleep disordered breathing. Respiratory failure is the most common cause of mortality in this population. Substantial progress has been made in diagnosis, monitoring and treatment for NMD over the last decade. Pulmonary function testing (PFT) is utilized to objectively measure respiratory pump function and PFT milestones are utilized in NMD-specific pulmonary care guidelines. New disease modifying therapies are approved for the treatment of patients with Duchenne muscular dystrophy and spinal muscular atrophy (SMA), including the first ever approved systemic gene therapy, in the case of SMA. Despite extraordinary progress in the medical management of NMD, little is known regarding the respiratory implications and long-term outcomes for patients in the era of advanced therapeutics and precision medicine. The combination of technological and biomedical advancements has increased the complexity of the medical decision-making process for patients and families, thus emphasizing the importance of balancing respect for autonomy with the other foundational principles of medical ethics. This review features an overview of PFT, noninvasive ventilation strategies, novel and developing therapies, as well as the ethical considerations specific to the management of patients with pediatric NMD.
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Affiliation(s)
| | - Caroline U A Okorie
- Department of Pediatrics, Stanford Children's Health, Stanford, California, USA
| | - Michael Y McCown
- Department of Pediatrics, Inova Children's Hospital, Fairfax, Virginia, USA
| | - Fei J Dy
- Department of Pediatrics, University of Massachusetts Chan Medical School, Worcester, Massachusetts, USA
| | - Sandeep Puranik
- Department of Pediatrics, Riley Hospital for Children, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Moshe Prero
- Department of Pediatrics, Rainbow Babies and Children's Hospital, Cleveland, Ohio, USA
| | - Mai K ElMallah
- Department of Pediatrics, Duke University Medical Center, Durham, North Carolina, USA
| | - Lauren Treat
- Department of Pediatrics, University of Colorado School of Medicine, Aurora, Colorado, USA
| | - Jane E Gross
- Department of Pediatrics, University of Colorado School of Medicine, Aurora, Colorado, USA
- Departments of Pediatrics and Medicine, National Jewish Health, Denver, Colorado, USA
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Sansom-Daly UM, Zhang M, Evans HE, McLoone J, Wiener L, Cohn RJ, Anazodo A, Patterson P, Wakefield CE. Adapting the Voicing My CHOiCES Advance Care Planning Communication Guide for Australian Adolescents and Young Adults with Cancer: Appropriateness, Acceptability, and Considerations for Clinical Practice. Cancers (Basel) 2023; 15:2129. [PMID: 37046790 PMCID: PMC10093261 DOI: 10.3390/cancers15072129] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2023] [Revised: 03/25/2023] [Accepted: 03/26/2023] [Indexed: 04/05/2023] Open
Abstract
Background: Adolescents and young adults (AYAs) with life-threatening illnesses need support to discuss and voice their end-of-life choices. Voicing My CHOiCES (VMC) is a research-informed American advanced care planning guide designed to help facilitate these difficult discussions. This multi-perspective study aimed to evaluate its appropriateness, acceptability, and clinical considerations for Australian AYAs with cancer. Procedure: Forty-three participants including AYAs who were either undergoing or recently completed cancer treatment, their parents, and multidisciplinary health professionals assessed the acceptability of each VMC section quantitatively (appropriateness-yes/no, helpfulness and whether content caused stress-1 = not at all, to 5 = very) and qualitatively (sources of stress). AYAs also assessed the benefit and burden of completing several sections of the document, to inform clinical considerations. We conducted a mixed-methods analysis to obtain descriptive statistics and to identify prominent themes. Results: In terms of acceptability, almost all participants (96%) rated VMC as appropriate overall. Perceived helpfulness to their situation (to themselves/their child/their patients), to others, and stressfulness were rated, on average, as 4.1, 4.0, and 2.7/5, respectively. Stress was attributed to individual and personal factors, as well as interpersonal worries. All sections were considered more beneficial than burdensome, except for the Spiritual Thoughts section (Section 6). Conclusions: While VMC is an acceptable advance care planning guide for AYAs with cancer, changes to the guide were suggested for the Australian context. Health professionals implementing VMC will need to address and mitigate anticipated sources of stress identified here. Future research evaluating the impact of a new culturally adapted Australian VMC guide is an important next step. Finally, the clinical implications of the present study are suggested.
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Affiliation(s)
- Ursula M. Sansom-Daly
- School of Clinical Medicine, UNSW Medicine & Health, Randwick Clinical Campus, Discipline of Paediatrics, UNSW Sydney, Kensington, NSW 2052, Australia
- Behavioural Sciences Unit, Kids Cancer Centre, Sydney Children’s Hospital, Randwick, NSW 2031, Australia
- Sydney Youth Cancer Service, Nelune Comprehensive Cancer Centre, Prince of Wales Hospital, Randwick, NSW 2031, Australia
| | - Megan Zhang
- School of Clinical Medicine, UNSW Medicine & Health, Randwick Clinical Campus, Discipline of Paediatrics, UNSW Sydney, Kensington, NSW 2052, Australia
- Behavioural Sciences Unit, Kids Cancer Centre, Sydney Children’s Hospital, Randwick, NSW 2031, Australia
| | - Holly E. Evans
- School of Clinical Medicine, UNSW Medicine & Health, Randwick Clinical Campus, Discipline of Paediatrics, UNSW Sydney, Kensington, NSW 2052, Australia
- Behavioural Sciences Unit, Kids Cancer Centre, Sydney Children’s Hospital, Randwick, NSW 2031, Australia
| | - Jordana McLoone
- School of Clinical Medicine, UNSW Medicine & Health, Randwick Clinical Campus, Discipline of Paediatrics, UNSW Sydney, Kensington, NSW 2052, Australia
- Behavioural Sciences Unit, Kids Cancer Centre, Sydney Children’s Hospital, Randwick, NSW 2031, Australia
| | - Lori Wiener
- National Institutes of Health, Bethesda, MD 20892, USA
| | - Richard J. Cohn
- School of Clinical Medicine, UNSW Medicine & Health, Randwick Clinical Campus, Discipline of Paediatrics, UNSW Sydney, Kensington, NSW 2052, Australia
- Behavioural Sciences Unit, Kids Cancer Centre, Sydney Children’s Hospital, Randwick, NSW 2031, Australia
| | - Antoinette Anazodo
- School of Clinical Medicine, UNSW Medicine & Health, Randwick Clinical Campus, Discipline of Paediatrics, UNSW Sydney, Kensington, NSW 2052, Australia
- Kids Cancer Centre, Sydney Children’s Hospital, Randwick, NSW 2031, Australia
| | - Pandora Patterson
- Canteen Australia, Sydney, NSW 2042, Australia
- Faculty of Medicine and Health, The University of Sydney, Sydney, NSW 2006, Australia
| | - Claire E. Wakefield
- School of Clinical Medicine, UNSW Medicine & Health, Randwick Clinical Campus, Discipline of Paediatrics, UNSW Sydney, Kensington, NSW 2052, Australia
- Behavioural Sciences Unit, Kids Cancer Centre, Sydney Children’s Hospital, Randwick, NSW 2031, Australia
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Jacobs S, Davies N, Butterick KL, Oswell JL, Siapka K, Smith CH. Shared decision-making for children with medical complexity in community health services: a scoping review. BMJ Paediatr Open 2023; 7:10.1136/bmjpo-2023-001866. [PMID: 37012004 PMCID: PMC10083859 DOI: 10.1136/bmjpo-2023-001866] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2023] [Accepted: 03/02/2023] [Indexed: 04/05/2023] Open
Abstract
BACKGROUND Children with medical complexity is an increasing population whose parents and healthcare providers face multiple decisions. Shared decision-making is a process where patients, their families and healthcare providers collaborate to make decisions based on clinical evidence and informed preferences of the family. Shared decision-making has benefits for the child, family and healthcare providers, including improved parental understanding of the child's difficulties, increased participation, improved coping skills and more efficient healthcare use. It is, however, poorly implemented. AIMS AND METHODS A scoping review was conducted to explore shared decision-making for children with medical complexity in community health services, including how shared decision-making is defined in research, how it is implemented, including barriers and facilitators and recommendations for research. Six databases were systematically searched for papers published in English up to May 2022: Medline, CINAHL, EMBASE, PsycINFO, PubMed, Cochrane Database of Systematic Reviews and sources of grey literature. The review is reported according to the Preferred Reporting Items for Scoping Reviews. RESULTS Thirty sources met the inclusion criteria. Most factors can either be a facilitator or barrier to shared decision-making depending on the context. Two significant barriers to shared decision-making in this population include uncertainty about the child's diagnosis, prognosis, and treatment options and the presence of hierarchy and power imbalance during clinical encounters with healthcare providers. Further influencing factors include continuity of care, the availability of accurate, accessible, adequate, and balanced information and the interpersonal and communication skills of parents and healthcare providers. CONCLUSION Uncertainty about diagnosis, prognosis and treatment outcomes for children with medical complexity are additional challenges to the known barriers and facilitators to shared decision-making in community health services. Effective implementation of shared decision-making requires advancement of the evidence base for children with medical complexity, reducing power imbalance in clinical encounters, improving continuity of care, and improving the availability and accessibility of information resources.
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Affiliation(s)
- Sonja Jacobs
- Community Children's Therapies, Barts Health NHS Trust, London, UK
| | - Nathan Davies
- Research Department of Primary Care & Population Health, University College London, London, UK
| | | | - Jane L Oswell
- Community Children's Therapies, Barts Health NHS Trust, London, UK
| | | | - Christina H Smith
- Division of Psychology and Language Sciences, University College London, London, UK
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Lambert A, Pratt A, Conard LAE, Grigg Dean E, Page E, Vaughn LM, Lipstein EA. Supporting Gender-Related Medical Decision Making for Transgender and Gender-Diverse Individuals: A Scoping Review. Transgend Health 2023; 8:113-123. [PMID: 37013094 PMCID: PMC10066778 DOI: 10.1089/trgh.2021.0030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Purpose Transgender and gender-diverse (TGD) individuals and their families face numerous challenging decisions. To better understand their decision processes, we conducted a scoping review of the existing literature and of decision-support tools in use at pediatric gender-care clinics. Methods We searched PubMed, EMBASE, Scopus CINAHL, PsychINFO, and EBM Reviews for studies that were original research focused on decisions, decision making, or decision support for TGD individuals and/or their families. All studies were reviewed for inclusion by at least two researchers. Additionally, we reviewed clinical tools used to support decision making by TGD youth and their families. Results We retrieved 3306 articles. Thirty-two met criteria for data extraction. Studies focused on three major decisions: gender-confirming surgery, fertility preservation, and gender-affirming hormone therapy. Several themes that cut across clinical topics emerged: decision-making processes, decision-making roles, and sources of decision support. Only three articles focused on decision-support interventions, two of which discussed development of support tools and one evaluated a class designed to help with surgical decision making. None of the clinical tools reviewed met criteria for a decision aid. Conclusions There is a dearth of studies related to decision support interventions, an absence validated by the resources currently in clinical use. This scoping review suggests an opportunity for the development of tools to aid in the decision-making processes for TGD youth and their families.
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Affiliation(s)
- Amy Lambert
- Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| | - Ashli Pratt
- Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| | - Lee Ann E. Conard
- Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
| | - Elaine Grigg Dean
- Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| | - Erica Page
- Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| | - Lisa M. Vaughn
- Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
| | - Ellen A. Lipstein
- Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
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Chang LS, Kuo HC, Suen JJB, Yang PH, Hou CP, Sun HR, Lee ZM, Huang YH. Multimedia Mixed Reality Interactive Shared Decision-Making Game in Children with Moderate to Severe Atopic Dermatitis, a Pilot Study. CHILDREN 2023; 10:children10030574. [PMID: 36980133 PMCID: PMC10047264 DOI: 10.3390/children10030574] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/05/2023] [Revised: 03/07/2023] [Accepted: 03/15/2023] [Indexed: 03/19/2023]
Abstract
(1) Objective: Atopic dermatitis (AD) is a recurring skin disease that affects children’s daily activities and sleep quality. Due to the limitations of children’s understanding and ability to express themselves, shared decision making (SDM) is often made by guardians, which thus affects the acceptance and effectiveness of children’s treatments. Previous studies have demonstrated that involving both children and parents in decision making may help improve treatment outcomes; thus, we designed a multimedia mixed reality (MR) interactive game of SDM for children with moderate to severe AD. (2) Methods: Research participants included 6–18-year-old patients with moderate to severe AD. This research consisted of the following steps: designing SDM; character setting and visual design; performing games; system modification and optimization; screen editing and dubbing; and user testing and questionnaires by the System Usability Scale (SUS). (3) Results: We completed the SDM design for children with moderate to severe AD. Four different treatments were biologics, oral immune-modulating drugs, phototherapy, and wet wrap. An animated PowerPoint slide showed the AD apple rolling around before treatments and the AD apple sleeping soundly after treatments. Instructions with video teaching for the four different treatments were played, and then, the MR was turned on so that the patients could help the AD apple in the metaverse to undergo these four treatments. A total of 12 moderate to severe AD patients and six control patients used the game, all aged between six and eighteen years old, with an average SUS score of 81.0 and a standard error of 2.1 points. Adjective ratings yielded a rating between good and excellent. The game showed acceptable usability. We found no statistically significant differences in SUS scores between patients with and without moderate to severe AD or between boys and girls nor significant associations between SUS and age or severity. The analysis identified that the two items with the lowest SUS scores were “I think that I would need the support of a technical person to be able to use this product” and “I needed to learn a lot of things before I could get going with this product”. Both of these comments show the limitations of this game. (4) Conclusions: Overall, this study provides the first MR SDM game that has passed the SUS and can be used as an aid in clinical SDM.
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Affiliation(s)
- Ling-Sai Chang
- Department of Pediatrics, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung 83301, Taiwan
- Correspondence:
| | - Ho-Chang Kuo
- Department of Pediatrics, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung 83301, Taiwan
| | - Jason Jyh-Bin Suen
- Department of Digital Media Design, I-Shou University, Kaohsiung 83301, Taiwan
| | - Pei-Hsin Yang
- Department of Nursing and Pediatric Ward, Chang Gung Memorial Hospital-Kaohsiung Medical Center, Kaohsiung 83301, Taiwan
| | - Chiu-Ping Hou
- Department of Nursing and Pediatric Ward, Chang Gung Memorial Hospital-Kaohsiung Medical Center, Kaohsiung 83301, Taiwan
| | - Hui-Ru Sun
- Department of Nursing and Pediatric Ward, Chang Gung Memorial Hospital-Kaohsiung Medical Center, Kaohsiung 83301, Taiwan
| | - Zon-Min Lee
- Department of Pharmacy, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung 83301, Taiwan
| | - Ying-Hsien Huang
- Department of Pediatrics, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung 83301, Taiwan
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Norbäck K, Höglund AT, Godskesen T, Frygner-Holm S. Ethical concerns when recruiting children with cancer for research: Swedish healthcare professionals' perceptions and experiences. BMC Med Ethics 2023; 24:23. [PMID: 36918868 PMCID: PMC10012289 DOI: 10.1186/s12910-023-00901-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2022] [Accepted: 03/03/2023] [Indexed: 03/16/2023] Open
Abstract
BACKGROUND Research is crucial to improve treatment, survival and quality of life for children with cancer. However, recruitment of children for research raises ethical challenges. The aim of this study was to explore and describe ethical values and challenges related to the recruitment of children with cancer for research, from the perspectives and experiences of healthcare professionals in the Swedish context. Another aim was to explore their perceptions of research ethics competence in recruiting children for research. METHODS An explorative qualitative study using semi-structured interviews with key informants. Seven physicians and ten nurses were interviewed. Interviews were analysed using inductive qualitative content analysis. RESULTS The respondents' ethical challenges and values in recruitment mainly concerned establishing relationships and trust, meeting informational needs, acknowledging vulnerability, and balancing roles and interests. Ensuring ethical competence was raised as important, and interpersonal and communicative skills were highlighted. CONCLUSION This study provides empirical insight into recruitment of children with cancer, from the perspectives of healthcare professionals. It also contributes to the understanding of recruitment as a relational process, where aspects of vulnerability, trust and relationship building are important, alongside meeting informational needs. The results provide knowledge on the complexities raised by paediatric research and underpin the importance of building research ethics competence to ensure that the rights and interests of children with cancer are protected in research.
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Affiliation(s)
- Kajsa Norbäck
- Centre for Research Ethics & Bioethics, Department of Public Health and Caring Sciences, Box 564, SE-751 22, Uppsala, Sweden.
| | - Anna T Höglund
- Centre for Research Ethics & Bioethics, Department of Public Health and Caring Sciences, Box 564, SE-751 22, Uppsala, Sweden
| | - Tove Godskesen
- Centre for Research Ethics & Bioethics, Department of Public Health and Caring Sciences, Box 564, SE-751 22, Uppsala, Sweden
- Department of Health Care Sciences, Palliative Research Centre, Marie Cederschiöld University, Box 11189, 100 61, Stockholm, Sweden
| | - Sara Frygner-Holm
- Centre for Research Ethics & Bioethics, Department of Public Health and Caring Sciences, Box 564, SE-751 22, Uppsala, Sweden
- Physiotherapy and behavioral medicine, Department of Women's and Children's Health, Box 593, 751 24, Uppsala, Sweden
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Acevedo Callejas ML, Zhou Y, Farrell EL, Foley KA. Providers' shared decision-making as a predictor of healthcare outcomes for college-aged adults managing upper respiratory tract infections. PATIENT EDUCATION AND COUNSELING 2023; 108:107619. [PMID: 36603471 DOI: 10.1016/j.pec.2022.107619] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/16/2022] [Revised: 11/08/2022] [Accepted: 12/30/2022] [Indexed: 06/17/2023]
Abstract
OBJECTIVES Strategies that assist patients with upper respiratory tract infections (URTIs) to endorse non-antibiotic treatments are vital to curbing antibiotic resistance. This study examines the potential of shared decision-making (SDM) for improving stewardship-relevant outcomes and investigates patient affect as a mechanism that explains the beneficial impact of perceived SDM. METHOD Patients (N = 433) seeking care for URTIs at a university student health center and not prescribed antibiotics completed a pre-visit questionnaire and two surveys one day and 14 days post-visit. The day-one survey assessed perceived SDM, affect, and immediate stewardship-relevant outcomes, and the day-14 survey assessed long-term stewardship-relevant outcomes. RESULTS Perceived SDM was negatively associated with negative affect and positively associated with positive affect, favorable perceptions of non-antibiotic treatments and providers, and self-efficacy to manage symptoms and obtain follow-up care. Patient affect and day-one outcomes were mediators between perceived SDM and retrospective self-efficacy two weeks post-visit. CONCLUSION The study illustrated the beneficial influence of patient perceived SDM on antibiotic stewardship in both short and long terms and elucidated the mechanisms through which the influence occurs. PRACTICE IMPLICATIONS SDM can be an effective strategy for primary care providers to improve patients' outcomes with URTI visits without prescribing unwarranted antibiotics.
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Affiliation(s)
| | - Yanmengqian Zhou
- Department of Communication Studies, Louisiana State University, Baton Rouge, USA.
| | - Erina L Farrell
- Department of Communication Arts & Sciences, Pennsylvania State University, University Park, USA
| | - Kasey A Foley
- Center for Tobacco Products, US Food and Drug Administration, Silver Spring, USA
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Decision Support Needs for Transgender and Gender-Diverse Youth and Families: A Patient-Centered Needs Assessment. J Adolesc Health 2023; 72:452-459. [PMID: 36535868 DOI: 10.1016/j.jadohealth.2022.10.022] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2022] [Revised: 10/12/2022] [Accepted: 10/13/2022] [Indexed: 12/23/2022]
Abstract
PURPOSE Due to the intertwining of medical and social decision-making, new approaches to shared decision-making are likely needed for supporting decisions related to the care of transgender and gender-diverse (TGD) adolescents. Prior to developing decision support interventions for TGD youth, a decision support needs assessment must be completed. METHODS Self-identified TGD youth, family members of TGD youth, clinicians caring for this population, and community advocates participated in one of six group level assessments (GLAs). GLA is a structured, participatory qualitative method that engages diverse groups of stakeholders in generating and evaluating ideas on the topic of interest. Upon completion of all GLAs, a survey was developed and distributed to GLA participants inviting them to rank ideas generated during the GLAs. RESULTS Six major themes emerged from the GLAs regarding decision support needs, including: improving healthcare provider skills and education, increasing access to support outside the healthcare system, strengthening community and societal support, developing special information resources, supporting youth in leading decision-making about transition, and modifying the healthcare system. In the follow-up survey, improving healthcare provider skills and education was the most commonly chosen top priority. DISCUSSION Participants identified decision support needs for TGD youth and their families that were mostly distinct from traditional decision support approaches. Participants' focus on the need to improve healthcare provider skills and education provides an opportunity to couple gender-focused education with shared decision-making skills, an approach that may be more sustainable than tools for specific decisions.
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Tadros HJ, Saidi A, Rawlinson AR, Cattier C, Black EW, Rackley J, Breault L, Pietra BA, Fricker FJ, Gupta D. Assessment of parental decision making in congenital heart disease, cardiomyopathy and heart transplantation: an observational study analysing decisional characteristics and preferences. Arch Dis Child 2023:archdischild-2022-324373. [PMID: 36732035 DOI: 10.1136/archdischild-2022-324373] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2022] [Accepted: 01/19/2023] [Indexed: 02/04/2023]
Abstract
OBJECTIVE We explore shared decision making (DM) in guardians of children with heart disease by assessing the desired weight of influence on DM and factors that may alter the relative weight of parent or medical team influence. METHODS Guardians of patients <21 years and admitted >1 week in the paediatric cardiac intensive care unit (PCICU) were recruited. Twelve vignettes were designed including technical (antibiotic selection, intubation, peripherally inserted central catheter placement, ventricular assist device placement, heart transplant, organ rejection, heart rhythm abnormalities and resuscitation effort) and non-technical vignettes (cessation of life-sustaining therapies, depression treatment, obesity and palliative care referral). Participants responded to questions on DM characteristics and one question querying preference for relative weight of parent or medical team influence on DM. RESULTS Of 209 participants approached, 183 were included. Most responded with equal desire of medical team and parental influence on DM in all vignettes (range 41.0%-66.7%). Technical scenarios formed one cluster based on DM characteristics, compared with non-technical scenarios. Factors that increase the relative weight of parental influence on DM include desired input and involvement in big-picture goals (OR 0.274, CI [0.217 to 0.346]; OR 0.794, CI [0.640 to 0.986]). Factors that increase the relative weight of medical team influence on DM include perception of medical expertise needed (OR 1.949 [1.630 to 2.330]), urgency (OR 1.373 [1.138 to 1.658]), benefit (OR 1.415 [1.172 to 1.710]), number of PCICU admissions (OR 1.134 [1.024 to 1.256]) and private insurance (OR 1.921 [1.144 to 3.226]). CONCLUSION Although factors may alter the weight of influence on DM, most parents desire equal parental and medical team influence on DM.
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Affiliation(s)
- Hanna J Tadros
- Department of Pediatrics, University of Florida, Gainesville, Florida, USA.,Section of Cardiology, Department of Pediatrics, Baylor College of Medicine, Houston, Texas, USA
| | - Arwa Saidi
- Department of Pediatrics, University of Florida, Gainesville, Florida, USA.,Congenital Heart Center, University of Florida, Gainesville, Florida, USA
| | - Alana R Rawlinson
- Department of Clinical and Health Psychology, University of Florida, Gainesville, Florida, USA
| | - Celine Cattier
- Department of Palliative Care, University of Florida, Gainesville, Florida, USA
| | - Erik W Black
- Department of Pediatrics, University of Florida, Gainesville, Florida, USA
| | - Jennifer Rackley
- Congenital Heart Center, University of Florida, Gainesville, Florida, USA
| | - Leah Breault
- Congenital Heart Center, University of Florida, Gainesville, Florida, USA
| | - Biagio A Pietra
- Department of Pediatrics, University of Florida, Gainesville, Florida, USA.,Congenital Heart Center, University of Florida, Gainesville, Florida, USA
| | - Fredrick J Fricker
- Department of Pediatrics, University of Florida, Gainesville, Florida, USA.,Congenital Heart Center, University of Florida, Gainesville, Florida, USA
| | - Dipankar Gupta
- Department of Pediatrics, University of Florida, Gainesville, Florida, USA .,Congenital Heart Center, University of Florida, Gainesville, Florida, USA
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Lara Carrion L, Bramstedt KA. Exploring the ethical complexity of pediatric organ transplant candidates and COVID-19 vaccination: Tensions between autonomy and beneficence, children and parents. Pediatr Transplant 2023; 27:e14408. [PMID: 36210480 PMCID: PMC9874860 DOI: 10.1111/petr.14408] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2022] [Revised: 08/08/2022] [Accepted: 09/17/2022] [Indexed: 11/05/2022]
Abstract
BACKGROUND POT is emotionally sensitive due to cohort vulnerability, their lack of decisional capacity, and waitlist mortality. The COVID-19 pandemic has added complexity to the setting of pediatric transplantation, as well as living donation, due to tensions about COVID-19 vaccination for recipients, donors, and parent-caregivers. METHODS In the context of COVID-19 vaccination, two ethicists present four pediatric donation and transplant dilemmas for ethical exploration and offer guidance to clinical teams, noting that mandates are controversial, and there is no global harmonization regarding requirements. RESULTS As with all vaccinations, they are a tool of organ stewardship aimed to optimize outcomes and, in the setting of pediatrics, ensure optimal caregiving for these vulnerable recipients. Current evidence supports the ethical permissibility of COVID-19 vaccination mandates for transplant candidates aged 6 months and older. CONCLUSION Our guidance considers the tensions of autonomy and beneficence and the ethical duty of organ stewardship. The harms of being unvaccinated and risking the harms of COVID-19 and long-COVID post-transplant support the ethical permissibility of vaccination mandates in countries where the vaccine has pediatric regulatory approval.
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Maillard J, Beckmann TS, Tramèr MR, Elia N. Reviewing next of kin regrets in surgical decision-making: cross-sectional analysis of systematically searched literature. J Patient Rep Outcomes 2023; 7:5. [PMID: 36695927 PMCID: PMC9877257 DOI: 10.1186/s41687-023-00539-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2022] [Accepted: 01/03/2023] [Indexed: 01/26/2023] Open
Abstract
BACKGROUND Decision-making concerning relatives undergoing surgery is challenging. It remains unclear to what extent implicated next of kin eventually regret their decisions and how this regret is assessed. Our aim was to systematically review the literature on decisional regret of next of kin and to describe the assessment tools used and the surgical populations studied. METHODS We included interventional or observational, quantitative or qualitative studies reporting the measurement of decisional regret of next of kin concerning relatives undergoing surgery. We searched a variety of databases without restriction on publication year. We assessed the quality of reporting of quantitative studies using the NIH Quality Assessment Tool for Observational Cohort and Cross-Sectional Studies and of qualitative studies using the Critical Appraisal Skills Program Checklist. RESULTS Thirteen cross-sectional, five prospective cohorts and five qualitative studies matched our inclusion criteria. In 18 studies (78%), patients were children, in five (22%), young or middle-aged adults. No study included elderly or frail patients. Thirteen studies (57%) used the original Decision Regret Scale which was validated for patients, but not for next of kin. Only 3 of the 18 (17%) quantitative studies and only one of the 4 (25%) qualitative studies were rated as "good" in the quality assessment. CONCLUSION None of the retrieved studies used validated tools to assess the decisional regret of next of kin and none of them examined this issue in elderly or frail surgical patients.
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Affiliation(s)
- Julien Maillard
- grid.150338.c0000 0001 0721 9812Division of Anesthesiology, Department of Anesthesiology, Pharmacology, Intensive Care and Emergency Medicine, Geneva University Hospitals, Rue Gabrielle-Perret-Gentil 4, 1205 Geneva, Switzerland
| | - Tal S. Beckmann
- grid.150338.c0000 0001 0721 9812Division of Anesthesiology, Department of Anesthesiology, Pharmacology, Intensive Care and Emergency Medicine, Geneva University Hospitals, Rue Gabrielle-Perret-Gentil 4, 1205 Geneva, Switzerland
| | - Martin R. Tramèr
- grid.150338.c0000 0001 0721 9812Division of Anesthesiology, Department of Anesthesiology, Pharmacology, Intensive Care and Emergency Medicine, Geneva University Hospitals, Rue Gabrielle-Perret-Gentil 4, 1205 Geneva, Switzerland
| | - Nadia Elia
- grid.150338.c0000 0001 0721 9812Division of Anesthesiology, Department of Anesthesiology, Pharmacology, Intensive Care and Emergency Medicine, Geneva University Hospitals, Rue Gabrielle-Perret-Gentil 4, 1205 Geneva, Switzerland
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Watson D, Mhlaba M, Molelekeng G, Chauke TA, Simao SC, Jenner S, Ware LJ, Barker M. How do we best engage young people in decision-making about their health? A scoping review of deliberative priority setting methods. Int J Equity Health 2023; 22:17. [PMID: 36698119 PMCID: PMC9876416 DOI: 10.1186/s12939-022-01794-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2022] [Accepted: 11/18/2022] [Indexed: 01/26/2023] Open
Abstract
INTRODUCTION International organisations have called to increase young people's involvement in healthcare and health policy development. We currently lack effective methods for facilitating meaningful engagement by young people in health-related decision-making. The purpose of this scoping review is to identify deliberative priority setting methods and explore the effectiveness of these in engaging young people in healthcare and health policy decision-making. METHODS Seven databases were searched systematically, using MeSH and free text terms, for articles published in English before July 2021 that described the use of deliberative priority setting methods for health decision-making with young people. All titles, abstracts and full-text papers were screened by a team of six independent reviewers between them. Data extraction followed the Centre for Reviews and Dissemination guidelines. The results are presented as a narrative synthesis, structured around four components for evaluating deliberative processes: 1) representation and inclusion of diverse participants, 2) the way the process is run including levels and timing of participant engagement, 3) the quality of the information provided to participants and 4) resulting outcomes and decisions. FINDINGS The search yielded 9 reviews and 21 studies. The more engaging deliberative priority setting tools involved young people-led committees, mixed methods for identifying and prioritising issues and digital data collection and communication tools. Long-term and frequent contact with young people to build trust underpinned the success of some of the tools, as did offering incentives for taking part and skills development using creative methods. The review also suggests that successful priority setting processes with young people involve consideration of power dynamics, since young people's decisions are likely to be made together with family members, health professionals and academics. DISCUSSION Young people's engagement in decision-making about their health is best achieved through investing time in building strong relationships and ensuring young people are appropriately rewarded for their time and contribution. If young people are to be instrumental in improving their health and architects of their own futures, decision-making processes need to respect young people's autonomy and agency. Our review suggests that methods of power-sharing with young people do exist but that they have yet to be adopted by organisations and global institutions setting global health policy.
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Affiliation(s)
- Daniella Watson
- Global Health Research Institute, Human Development and Health, Faculty of Medicine, University of Southampton, Southampton, UK. .,SAMRC Developmental Pathways for Health Research Unit, School of Clinical Medicine, University of the Witwatersrand, Johannesburg, South Africa. .,Department of Global Health and Social Medicine, King's College London, London, UK.
| | - Mimi Mhlaba
- grid.11951.3d0000 0004 1937 1135SAMRC Developmental Pathways for Health Research Unit, School of Clinical Medicine, University of the Witwatersrand, Johannesburg, South Africa
| | - Gontse Molelekeng
- grid.11951.3d0000 0004 1937 1135SAMRC Developmental Pathways for Health Research Unit, School of Clinical Medicine, University of the Witwatersrand, Johannesburg, South Africa
| | - Thulani Andrew Chauke
- grid.412801.e0000 0004 0610 3238Department of Adult, College of Education, Community and Continuing Education, University of South Africa, Pretoria, South Africa
| | - Sara Correia Simao
- grid.5491.90000 0004 1936 9297Medical Research Council Lifecourse Epidemiology Centre, University of Southampton, Southampton, UK
| | - Sarah Jenner
- grid.5491.90000 0004 1936 9297Medical Research Council Lifecourse Epidemiology Centre, University of Southampton, Southampton, UK
| | - Lisa J. Ware
- grid.11951.3d0000 0004 1937 1135SAMRC Developmental Pathways for Health Research Unit, School of Clinical Medicine, University of the Witwatersrand, Johannesburg, South Africa ,grid.11951.3d0000 0004 1937 1135DSI-NRF Centre of Excellence in Human Development, University of the Witwatersrand, Johannesburg, South Africa
| | - Mary Barker
- grid.5491.90000 0004 1936 9297Global Health Research Institute, Human Development and Health, Faculty of Medicine, University of Southampton, Southampton, UK ,grid.5491.90000 0004 1936 9297School of Health Sciences, Faculty of Life and Environmental Sciences, University of Southampton, Southampton, UK ,grid.11951.3d0000 0004 1937 1135School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa ,grid.430506.40000 0004 0465 4079NIHR Southampton Biomedical Research Centre, University Hospitals Southampton NHS Foundation Trust, Southampton, UK
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Arenth J, Turnbull J, Pichert J, Webb L, Pituch K. Teaching the Skill of Shared Decision Making Utilizing a Novel Online Module: A Pilot Randomized Controlled Study. Hosp Pediatr 2023; 13:17-23. [PMID: 36510747 DOI: 10.1542/hpeds.2022-006679] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
OBJECTIVES In this pilot study, we developed and tested an online educational module for the purpose of teaching optimal shared decision making (SDM) behaviors for physicians in training. We hypothesized that those who received this intervention would show significant improvement in SDM behaviors afterward as compared with those who had not received the intervention. METHODS Pediatric subspecialty fellows (pediatric critical care medicine, neonatology, hematology and oncology, and pulmonology) at the Monroe Carell Jr Children's Hospital at Vanderbilt were eligible to participate, if approved by their respective program directors. Design was a randomized crossover trial of an online educational module to promote behaviors essential to SDM. Participants were randomized by subspecialty. Experts in clinical communication blinded to participants' study arms evaluated SDM behaviors in video-taped clinical simulations with standardized parent dyads. The study protocol was approved by the Vanderbilt University Institutional Review Board. RESULTS Participants receiving the intervention were approximately 40 times more likely to improve their subsequent total score when compared with simply repeating the simulation alone (95% confidence interval, 1.72-919.29; P = .022). CONCLUSIONS This pilot study demonstrates that an online, interactive module can be an effective way of teaching the skill of SDM to pediatric subspecialty trainees. Tools like this one could help overcome the limitations inherent in currently published SDM resources and meet the need for interventions with demonstrated effectiveness, helping to increase the utilization of SDM skills by providing primary or supplemental education at institutions across the resource spectrum.
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Affiliation(s)
- Joshua Arenth
- Shawn Jenkins Children's Hospital at the Medical University of South Carolina, Charleston, South Carolina
| | - Jessica Turnbull
- Monroe Carell Jr. Children's Hospital at Vanderbilt and Center for Biomedical Ethics and Society, Vanderbilt University Medical Center, Nashville, Tennesee
| | - James Pichert
- Vanderbilt Center for Patient and Professional Advocacy, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Lynn Webb
- Vanderbilt Center for Patient and Professional Advocacy, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Ken Pituch
- C.S. Mott Children's Hospital at the University of Michigan, Ann Arbor, Michigan
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Hirata M, Kobayashi K. Experiences with the end-of-life decision-making process in children with cancer, their parents, and healthcare professionals: A systematic review and meta-ethnography. J Pediatr Nurs 2022; 69:e45-e64. [PMID: 36586777 DOI: 10.1016/j.pedn.2022.12.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2022] [Revised: 12/04/2022] [Accepted: 12/07/2022] [Indexed: 12/31/2022]
Abstract
BACKGROUND Decision-making during the end-of-life (EOL) phase for children with cancer is extremely difficult for parents. We synthesized the qualitative experiences of children with cancer, parents, and healthcare professionals (HCPs), and their social interactions during the EOL decision-making process in the pediatric oncology setting. METHODS Meta-ethnography was used to conduct a systematic review and meta-synthesis. We searched four online databases to identify original studies published in English and Japanese and examined 21 relevant studies. Two Japanese reviewers discussed the differences/relationships and included studies that synthesized the translated qualitative findings. A conceptual model of social interactions was created. RESULTS We identified four themes regarding children's, parents', and HCPs' experiences: hope and confrontation with the child's death, guidance and support during uncertainty, awareness of being protected and having hope, and mutual unspoken integration of values. CONCLUSIONS These themes evince the experiences of children, parents, and HCPs during the EOL decision-making process and suggests a complex three-way social interaction model. While considering such distinctive social interactions during a child's EOL, this study revealed the sharing of prudent information and psychosocial support by HCPs. The findings indicate that hope and uncertainty are key elements for effectively understanding the experiences of children and parents and that EOL decision-making should not be rushed but should be supported by leaving room for uncertainty and acknowledging parents' emotional needs and fostering new hope. Further research into how hope can be further supported in situations that are rife with uncertainty is needed.
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Affiliation(s)
- Mika Hirata
- Department of Nursing, School of Health and Social Services, Saitama Prefectural University, 820 Sannomiya, Koshigaya-shi, Saitama 343-8540, Japan.
| | - Kyoko Kobayashi
- Graduate School of Nursing Science, St. Luke's International University, 10-1 Akashi-cho, Chuo-ku, Tokyo 104-0044, Japan
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Nageswaran S, Gower WA, Golden SL, King NMP. Collaborative decision-making: A framework for decision-making about life-sustaining treatments in children with medical complexity. Pediatr Pulmonol 2022; 57:3094-3103. [PMID: 36098220 PMCID: PMC9825978 DOI: 10.1002/ppul.26140] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2022] [Revised: 08/28/2022] [Accepted: 09/09/2022] [Indexed: 01/12/2023]
Abstract
OBJECTIVE Caregivers of children with medical complexity (CMC) face decisions about life-sustaining treatments (LST) like tracheostomy. We sought to develop a clinically relevant and realistic model for decision-making about tracheostomy placement that might apply to other LST in CMC. DESIGN This qualitative study, conducted between 2013 and 2015, consisted of 41 interviews with 56 caregivers of CMC who had received tracheostomies and 5 focus groups of 33 healthcare providers (HCPs) at a tertiary-care children's hospital in North Carolina. Participants were asked about their perspectives on the tracheostomy decision-making process. Data were transcribed, and coded. Using thematic content analysis, we inductively developed a tracheostomy decision-making framework and process. RESULTS Many factors influenced caregivers' decisions, including children's well-being and caregivers' values, faith, knowledge, experience, emotional state, and social factors; preserving the child's life was the most important. HCPs consider many clinical and nonclinical factors; recommending tracheostomy for children with limited survival, perceived poor functioning and quality of life, and progressive conditions is ethically difficult. The framework of tracheostomy decision-making has inter-related caregiver- and HCP-level factors that influence the process. The framework contains elements not captured in a shared decision-making model, but better fits a collaborative decision-making (CDM) model. The tracheostomy CDM process that emerged from the data has two nonsequential components that HCPs could use: (1) gaining understanding and (2) holding decision-making conversations. CONCLUSIONS CDM could be a useful model for clinicians guiding families about tracheostomy for CMC. The applicability of CDM for decision-making about other LSTs needs further exploration.
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Affiliation(s)
- Savithri Nageswaran
- Department of PediatricsWake Forest University School of MedicineWinston‐SalemNorth CarolinaUSA
- Department of Social Sciences and Health PolicyWake Forest University School of MedicineWinston‐SalemNorth CarolinaUSA
| | - William A. Gower
- Department of PediatricsWake Forest University School of MedicineWinston‐SalemNorth CarolinaUSA
- Department of PediatricsUniversity of North Carolina at Chapel Hill School of MedicineChapel HillNorth CarolinaUSA
| | - Shannon L. Golden
- Qualitative Research ConsultantGoldsmith Research GroupWinston‐SalemNorth CarolinaUSA
| | - Nancy M. P. King
- Department of Social Sciences and Health PolicyWake Forest University School of MedicineWinston‐SalemNorth CarolinaUSA
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Warton C, McDougall RJ. Fertility preservation for transgender children and young people in paediatric healthcare: a systematic review of ethical considerations. JOURNAL OF MEDICAL ETHICS 2022; 48:1076-1082. [PMID: 34980674 PMCID: PMC9726968 DOI: 10.1136/medethics-2021-107702] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/29/2021] [Accepted: 10/03/2021] [Indexed: 05/11/2023]
Abstract
BACKGROUND While fertility preservation is recommended practice for paediatric oncology patients, it is increasingly being considered for transgender children and young people in paediatric care. This raises ethical issues for clinicians, particularly around consent and shared decision-making in this new area of healthcare. METHODS A systematic review of normative literature was conducted across four databases in June 2020 to capture ethical considerations related to fertility counselling and preservation in paediatric transgender healthcare. The text of included publications was analysed inductively, guided by the Qualitative Analysis Guide of Leuven. RESULTS Twenty-four publications were identified for inclusion. Four key ethical considerations emerged from this literature: access to fertility preservation, conscientious objection, decision-making capacity of children and young people, and shared decision-making. CONCLUSION In the identified literature, there is consensus that transgender children and young people should not be refused access to fertility preservation services solely due to their gender identity, and that clinicians with conscientious objections to fertility preservation for this group have an obligation to refer on to willing providers. Factors that create ethical complexity in this area of paediatric care include the child's age, mental health, and parents' views.
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Affiliation(s)
- Chanelle Warton
- Centre for Health Equity, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Victoria, Australia
| | - Rosalind J McDougall
- Centre for Health Equity, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Victoria, Australia
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