Division of Otolaryngology-Head and Neck Surgery, Department of Surgery, Dalhousie University, Halifax, Nova Scotia, Canada.
Division of Otolaryngology-Head and Neck Surgery, University of Utah School of Medicine, Salt Lake City, Utah, USA.
Eur Ann Otorhinolaryngol Head Neck Dis. 2019 Jun;136(3S):S15-S19. doi: 10.1016/j.anorl.2018.09.002. Epub 2018 Oct 12.
Shared decision-making (SDM) is a collaborative process in which patients and family members make healthcare decisions together with their clinician. The objective of this study was to explore how pediatric otolaryngologists involve parents in SDM and which factors influence this process.
Ninety-six children being assessed by pediatric otolaryngologists at a tertiary healthcare center for elective surgical procedures (adeno/tonsillectomy or tympanostomy tube insertion) were prospectively enrolled into the study. Surgical consultations were video-recorded and coded using the OPTION instrument to determine level of SDM. To provide a subjective measure of SDM, parents completed the Shared Decision-Making Questionnaire (SDM-Q-9) and surgeons completed the physician version of the questionnaire (SDM-Q-Doc).
Total mean child and parents OPTION scores were 3.16 (SD: 5.43, range: 0-21) and 11.38 (SD: 6.41, range: 1-27) out of 48 respectively. Clinicians were more likely to involve female children in SDM as well as children who had a previous history of surgery. There were no other significant correlations between total OPTION scores and patient/family demographics. A positive correlation was found between length of consultation and total OPTION scores for parents, but not for children. SDM-Q-9 and SDM-Q-Doc scores were not correlated with total OPTION scores.
Decision making during pediatric otolaryngology consultations mostly focused on treatment related decisions and sharing information as opposed to facilitating collaborative decision-making. Parent and physician perceptions of SDM were not correlated with actual observed behavior. Additional research is required to provide insight in how to increase surgeons' assistance towards SDM.
共同决策（SDM）是一个协作的过程，在这个过程中，患者及其家属与临床医生一起做出医疗决策。本研究的目的是探讨儿科耳鼻喉科医生如何让家长参与 SDM 以及哪些因素影响这一过程。
96 名在三级保健中心接受择期手术评估（腺样体/扁桃体切除术或鼓膜切开术置管）的儿童前瞻性纳入本研究。对手术咨询进行录像，并使用 OPTION 工具进行编码，以确定 SDM 的水平。为了提供 SDM 的主观衡量标准，家长完成了共同决策问卷（SDM-Q-9），外科医生完成了医生版问卷（SDM-Q-Doc）。
儿童和家长的 OPTION 总分平均为 3.16（SD：5.43，范围：0-21）和 11.38（SD：6.41，范围：1-27），分别为 48 分中的 48 分。临床医生更倾向于让女性儿童和有手术史的儿童参与 SDM。总 OPTION 评分与患者/家庭人口统计学特征之间没有其他显著相关性。咨询时间的长短与家长的总 OPTION 评分呈正相关，但与儿童的总 OPTION 评分无关。SDM-Q-9 和 SDM-Q-Doc 评分与总 OPTION 评分无相关性。
儿科耳鼻喉科咨询中的决策主要集中在与治疗相关的决策和信息共享，而不是促进协作决策。家长和医生对 SDM 的看法与实际观察到的行为没有相关性。需要进一步的研究来了解如何增加外科医生对 SDM 的帮助。
