Bioethics Center, Children's Mercy Kansas City, Kansas City, MO.
Endocrinology and Diabetes Clinic, Children's Mercy Kansas City, Kansas City, MO; Department of Pediatrics, University of Missouri-Kansas City School of Medicine, Kansas City, MO.
J Pediatr. 2020 May;220:237-240. doi: 10.1016/j.jpeds.2020.01.010. Epub 2020 Feb 6.
To compare parental attitudes about short stature over time and determine possible factors that predict changes in attitudes.
At baseline (1993-1994), we surveyed parents about their attitudes regarding their children's height. We compared parents of children (aged 4-15 years) referred to endocrinologists (referred, 154) with those of children with heights <10th percentile seen by pediatricians during regular visits (control, 240). At follow-up (2008-2009), 103 control and 98 referred parents completed a similar survey. We then made a logistic regression analysis to observe changes in perception. Primary variables included self-esteem, treatment by peers, and ability to cope with current height.
At baseline, referred parents perceived a worse impact of short stature on their children than did controls. At follow-up, instead, referred parents were 3.8 times more likely to report improvement in self-esteem, 2.4 times more likely to report improved treatment from peers, and 5.7 times more likely to report overall ability to cope with height than were unreferred parents. Perception of psychosocial improvement was greater in the referred than the control group. Referral was a stronger predictor of an improved follow-up response than patients' current height or change in height.
While incorporating parental attitudes into management decisions, clinicians should be aware that parental perceptions may change over time and that referral itself may lead parents to perceive psychosocial improvements over time.
比较父母对身材矮小的态度随时间的变化,并确定可能预测态度变化的因素。
在基线(1993-1994 年)时,我们调查了父母对子女身高的态度。我们比较了被内分泌医生转介的儿童(转介组,154 例)的父母和儿科医生在常规就诊时发现的身高处于第 10 百分位数以下的儿童(对照组,240 例)的父母。在随访(2008-2009 年)时,103 名对照组和 98 名转介组的父母完成了类似的调查。然后,我们进行了逻辑回归分析以观察感知的变化。主要变量包括自尊、同龄人对待和应对当前身高的能力。
在基线时,转介组父母认为矮小对子女的影响比对照组更严重。然而,在随访时,转介组父母报告自尊改善的可能性是对照组的 3.8 倍,报告同龄人治疗改善的可能性是对照组的 2.4 倍,报告总体应对身高的能力改善的可能性是对照组的 5.7 倍。转介组感知心理社会改善的程度大于对照组。与患者当前身高或身高变化相比,转介是预测随访反应改善的更强指标。
在将父母态度纳入管理决策时,临床医生应意识到父母的看法可能随时间而变化,而且转介本身可能会使父母随时间推移而感知到心理社会的改善。