Department of Pediatric Urology, Children's Hospital Colorado; Division of Urology, Department of Surgery, University of Colorado School of Medicine, Aurora, Colorado, USA.
Adult and Child Center for Outcomes Research and Delivery Science (ACCORDS), University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA.
J Pediatr Surg. 2021 Mar;56(3):620-625. doi: 10.1016/j.jpedsurg.2020.04.016. Epub 2020 Apr 29.
The purpose of this study was to understand pediatric urologists' perceived role of patient characteristics on discussions about treatment of infants with suspected UPJ obstruction.
We conducted semi-structured interviews with pediatric urologists from three geographically diverse sites. Interview domains included: clinical indications for surgery, discussions with parents, and consideration of parent socioeconomic factors. Transcribed data and field notes were analyzed using a team-based, inductive grounded theory approach.
Thirteen physicians were interviewed. Physicians reported a standardized approach to discussions to facilitate parental understanding. While they did not report overt consideration of demographics, they tailored discussions based on educational and cultural background and language barriers. Physicians also reported that concerns about risk of loss to follow up contributed to their treatment recommendations. Most physicians recognized that the lack of clear data often led to use of personal experience to guide recommendations.
Physicians recognize a gap in data to guide surgical decisions and utilize personal experience to augment this gap. They also recognize the influence of educational and language barriers on discussions with families and consider risk of loss to follow up when making recommendations, suggesting an implicit consideration of demographics. These findings suggest that development of evidence-based guidelines may reduce treatment variations.
Not applicable (qualitative research study written in compliance with COREQ guidelines).
本研究旨在了解小儿泌尿科医生对患儿特征在讨论婴儿疑似肾盂输尿管连接部梗阻治疗中的作用的看法。
我们在三个地理位置不同的地点对小儿泌尿科医生进行了半结构化访谈。访谈内容包括：手术的临床指征、与家长的讨论以及对家长社会经济因素的考虑。使用基于团队的归纳扎根理论方法对转录数据和现场记录进行分析。
共对 13 名医生进行了访谈。医生们报告说，他们采用了一种标准化的讨论方法，以促进家长的理解。尽管他们没有报告明显考虑人口统计学因素，但他们根据教育和文化背景以及语言障碍调整了讨论。医生们还报告说，对失去随访风险的担忧影响了他们的治疗建议。大多数医生认识到，缺乏明确的数据往往导致他们使用个人经验来指导建议。
医生们认识到数据在指导手术决策方面存在差距，并利用个人经验来弥补这一差距。他们还认识到教育和语言障碍对与家庭讨论的影响，并在提出建议时考虑到失去随访的风险，这表明他们在某种程度上考虑了人口统计学因素。这些发现表明，制定基于证据的指南可能会减少治疗的差异。
不适用（根据 COREQ 指南编写的定性研究）。
