Boss Emily F, Links Anne R, Saxton Ron, Cheng Tina L, Beach Mary Catherine
1 Johns Hopkins University, Baltimore, MD, USA.
Clin Pediatr (Phila). 2017 Oct;56(11):993-1000. doi: 10.1177/0009922817702939. Epub 2017 Apr 21.
Sleep-disordered breathing (SDB) is prevalent in children and most commonly treated by surgery with adenotonsillectomy. We aimed to learn physician perspectives of social and communication factors that influence decision making for treatment of pediatric SDB. Purposive sampling identified 10 physician key informants across disciplines and practice settings, who participated in semistructured interviews regarding SDB care experiences and communication with parents. Interviews were analyzed using directed qualitative content analysis. Physicians provided a variety of perspectives on decision making for treatment that fell into 3 overarching themes: approach to surgery and alternatives, communication and decision making with families, and sociocultural factors/barriers to care. Perspectives were moderately heterogeneous, suggesting that individual social and relational elements may significantly influence how physicians refer patients and recommend treatment, and how parents choose surgery for this prevalent condition. These findings will inform development of culturally competent communication strategies and support tools to enhance shared decision making for physicians treating children with SDB.
睡眠呼吸障碍（SDB）在儿童中很普遍，最常见的治疗方法是腺样体扁桃体切除术。我们旨在了解医生对影响小儿SDB治疗决策的社会和沟通因素的看法。目的抽样确定了10名跨学科和执业环境的医生关键信息提供者，他们参与了关于SDB护理经验以及与家长沟通的半结构化访谈。使用定向定性内容分析法对访谈进行了分析。医生们对治疗决策提供了多种观点，可归纳为3个总体主题：手术方法及替代方案、与家庭的沟通及决策，以及社会文化因素/护理障碍。观点存在一定程度的异质性，这表明个体的社会和关系因素可能会显著影响医生转诊患者和推荐治疗的方式，以及家长为这种常见病症选择手术的方式。这些发现将为制定具有文化胜任力的沟通策略和支持工具提供参考，以加强治疗小儿SDB的医生的共同决策。
