Department of Urology, Indiana University School of Medicine, Indianapolis, IN, USA; Department of Pediatrics, Center for Pediatric and Adolescent Comparative Effectiveness Research, Indiana University School of Medicine, Indianapolis, IN, USA.
Department of Urology, Indiana University School of Medicine, Indianapolis, IN, USA.
J Pediatr Urol. 2020 Jun;16(3):307-315. doi: 10.1016/j.jpurol.2020.03.015. Epub 2020 Mar 26.
Many parents experience decisional conflict and decisional regret around hypospadias surgery. The utilization of a shared decision-making (SDM) process may mitigate these issues, however addressing the principal components of the SDM process is a complex task that requires the investment of providers.
The purpose of this study was to facilitate a discussion about SDM anchored on hypospadias with pediatric urology and general pediatric providers to explore perspectives, clinical applications and barriers to adopting SDM in clinical practice.
We conducted two focus groups in order to engage pediatric urology and general pediatric providers in guided discussions about SDM anchored on hypospadias. All activities were audio recorded and professionally transcribed. The transcripts were analyzed by three coders using directed qualitative content analysis techniques to identify themes and relationships between themes to inform the development of an affinity diagram (Extended Summary Figure).
Two focus groups were held; one with seven pediatric urology providers in November 2018 and one with ten general pediatric providers in January 2019 (median age 51 years, 88.2% Caucasian, 58.8% female, 70.6% physicians and 29.4% nurse practitioners). Both groups identified some of the key components of SDM including engaging families in decision-making, informing them about treatment options and clarifying values/preferences (Extended Summary Figure). They thought that SDM was useful for discussing preference-sensitive conditions (e.g. hypospadias) and addressing parental compliance. General pediatric providers also suggested that SDM helped them avoid unnecessary referrals to specialists. Both groups identified parental, provider and systemic barriers to the adoption of SDM: a) desire for paternalism, b) misperceptions about medical evidence, c) completion of parental decision-making prior to the clinical visit, d) provider bias/lack of interest and e) time constraints/productivity pressures.
Providers who care for hypospadias patients are knowledgeable about SDM and its potential clinical applications. They identified several potentially modifiable barriers to the adoption of a SDM process about hypospadias surgery in a pediatric clinical setting.
Based on feedback from providers, we plan to implement a hypospadias decision aid early in the parental decision-making process about hypospadias such as in the postpartum unit and at well-child visits in the newborn period and provide a provider training session about SDM to address the identified knowledge gaps.
许多父母在进行尿道下裂手术时会经历决策冲突和决策后悔。利用共享决策（SDM）过程可能会减轻这些问题，但是解决 SDM 过程的主要组成部分是一项复杂的任务，需要提供者的投入。
本研究的目的是通过与小儿泌尿外科和普通儿科提供者进行关于尿道下裂的 SDM 讨论，促进 SDM 的讨论，以探讨在临床实践中采用 SDM 的观点、临床应用和障碍。
我们进行了两次焦点小组讨论，以使小儿泌尿外科和普通儿科提供者参与关于尿道下裂的 SDM 指导讨论。所有活动均进行录音，并由专业人员进行转录。使用定向定性内容分析技术对转录本进行了三位编码员的分析，以确定主题和主题之间的关系，为亲和图（扩展摘要图）的开发提供信息。
共进行了两次焦点小组讨论；一次是在 2018 年 11 月与 7 名小儿泌尿外科医生进行的讨论，另一次是在 2019 年 1 月与 10 名普通儿科医生进行的讨论（中位年龄 51 岁，88.2%为白种人，58.8%为女性，70.6%为医生，29.4%为护士从业者）。两组人员都确定了 SDM 的一些关键组成部分，包括让家庭参与决策、告知他们有关治疗选择和澄清价值观/偏好（扩展摘要图）。他们认为 SDM 对于讨论敏感偏好条件（例如尿道下裂）和解决父母的依从性很有用。普通儿科医生还建议 SDM 可以帮助他们避免不必要地转介给专家。两组人员都确定了采用 SDM 的父母、提供者和系统障碍：a）家长式作风的愿望，b）对医学证据的误解，c）在临床就诊前完成父母的决策，d）提供者偏见/缺乏兴趣，e）时间限制/生产力压力。
治疗尿道下裂患者的提供者了解 SDM 及其潜在的临床应用。他们确定了在小儿临床环境中采用 SDM 流程治疗尿道下裂手术的一些潜在可改变的障碍。
根据提供者的反馈，我们计划在父母对尿道下裂的决策过程早期实施尿道下裂决策辅助工具，例如在产后病房和新生儿期的常规就诊中，并提供有关 SDM 的提供者培训课程，以解决确定的知识差距。
