Papiez Kinga, Tutton Elizabeth, Phelps Emma E, Baird Janis, Costa Matthew L, Achten Juul, Gibson Phoebe, Perry Daniel C
Kadoorie, Oxford Trauma and Emergency Care, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, Oxford University, Oxford, UK.
Trauma and Major Trauma Centre, Oxford University Hospitals NHS Foundation Trust, John Radcliffe Hospital, Oxford, UK.
Bone Jt Open. 2021 Jun;2(6):359-364. doi: 10.1302/2633-1462.26.BJO-2020-0186.R1.
The aim of this study was to explore parents and young people's experience of having a medial epicondyle fracture, and their thoughts about the uncertainty regarding the optimal treatment.
Families were identified after being invited to participate in a randomized controlled trial of surgery or no surgery for displaced medial epicondyle fractures of the humerus in children. A purposeful sample of 25 parents (22 females) and five young people (three females, mean age 11 years (7 to 14)) from 15 UK hospitals were interviewed a mean of 39 days (14 to 78) from injury. Qualitative interviews were informed by phenomenology and themes identified to convey participants' experience.
The results identify parents' desire to do the best for their child expressed through two themes: 1) 'uncertainty' (being uncertain about the best treatment option); and 2) 'facilitating recovery' (sharing the experience). Parents and young people were shocked when confronted with uncertainty about treatment and they felt responsible for the decision. They searched for further information, drew on their own experience, and struggled to weigh up risks of the treatments. Discussion with surgeons provided crucial support for decision-making, and young people were involved to a varying degree. In facilitating recovery, parents balanced increasing activity with protecting their child, but lacked knowledge about pain management, and how to improve strength and function of the arm. They hoped for a return to normal, including competitive sports.
Surgeons are aware of the impact of injury on children and their parents; however, they may be less aware of the turmoil created by treatment uncertainty. Confident surgeons who appreciate and contextualize the importance of pre-existing experience and beliefs are best placed to help the family develop confidence to embrace uncertainty, particularly regarding participation in clinical trials. Cite this article: 2021;2(6):359-364.
本研究旨在探究父母及青少年肱骨内上髁骨折的经历，以及他们对最佳治疗方案不确定性的看法。
在邀请家庭参与儿童肱骨移位性内上髁骨折手术或非手术随机对照试验后确定研究对象。从英国15家医院选取了25名父母（22名女性）和5名青少年（3名女性，平均年龄11岁（7至14岁））作为有目的的样本，受伤后平均39天（14至78天）接受访谈。定性访谈以现象学为依据，并确定主题以传达参与者的经历。
结果通过两个主题确定了父母希望为孩子做到最好的愿望：1）“不确定性”（对最佳治疗方案不确定）；2）“促进康复”（分享经历）。当面对治疗的不确定性时，父母和青少年感到震惊，他们觉得自己要对决策负责。他们寻求更多信息，借鉴自身经验，并努力权衡治疗的风险。与外科医生的讨论为决策提供了关键支持，青少年也不同程度地参与其中。在促进康复方面，父母在增加活动量和保护孩子之间取得平衡，但缺乏疼痛管理以及如何改善手臂力量和功能方面的知识。他们希望孩子能恢复正常，包括参加竞技体育。
外科医生意识到损伤对儿童及其父母的影响；然而，他们可能较少意识到治疗不确定性所带来的混乱。自信且能理解并结合既往经验和信念重要性的外科医生最有能力帮助家庭建立信心来接受不确定性，尤其是在参与临床试验方面。引用本文：2021；2(6):359 - 364。
