University of Iowa Hospitals and Clinics, Department of Urology, 200 Hawkins Drive, Iowa City, IA, 52242, USA.
University of Iowa Hospitals and Clinics, Department of Urology, 200 Hawkins Drive, Iowa City, IA, 52242, USA.
J Pediatr Urol. 2023 Oct;19(5):608-618. doi: 10.1016/j.jpurol.2023.05.015. Epub 2023 May 27.
Decisional conflict surrounding the topic of circumcision in the newborn male is assumed in some parents but has not been quantified or qualified. It is known that parents often base their decision on cultural and social factors and that physician discussions do affect ultimate decision-making. Information on parents' decision-making surrounding newborn circumcision and ways to mitigate conflict or uncertainty around the decision-making process is needed to better counsel them appropriately.
To identify the presence or absence of decisional conflict in parents-to-be deciding whether or not to circumcise their child as well as to identify determinants of this conflict to direct future educational measures.
Parents presenting to obstetrics clinic as well as contacted by institutional email were recruited using convenience sampling and completed the validated Decisional Conflict Scale (DCS). A smaller subset of subjects were recruited via institutional email to complete semi-structured interviews regarding the decision-making process and specifically uncertainty regarding the decision. Descriptive statistics and unpaired t tests were used for analysis of survey data. For interview data, an iterative, grounded theory methodology was used.
173 subjects completed the DCS. 12% of all participants had high decisional conflict. Intuitively, those who had not yet decided whether to circumcise had the highest proportion of high DCS (69%), followed by those who had decided to circumcise (9.3%) and those who had decided not to circumcise (1.7%). 24 subjects were interviewed, and based on their DCS scores and interview responses were classified as low, intermediate and high conflict. Three primary themes emerged delineating the high from low conflict groups. There were notable differences in the feelings of subjects regarding knowledge and feeling informed, the importance of particular values and clarity of the roles of these values in decision-making, and feelings of supported decision-making. These themes were used to create a visual model depicting the individual needs of each decision-maker (Fig. 1).
This study highlights the need for decision support for parents that is not only information-based but focuses on values clarity and supported decision-making. This study provides a jumping-off point for creation of shared decision-making tools directed at individual needs. The limitations of this study are a single institution design and homogeneous population, so when designing materials, additional unrecognized needs will likely be identified.
A small, but real proportion of parents-to-be experience significant uncertainty around the decision to circumcise their newborn boys. Identified needs of parents include feeling informed, feeling supported and clarification of important values related to the problem.
在一些父母中，围绕新生儿男性割礼主题的决策冲突是假设存在的，但尚未进行量化或定性。众所周知，父母的决策通常基于文化和社会因素，医生的讨论确实会影响最终的决策。为了更好地为他们提供适当的咨询，需要了解父母在新生儿割礼方面的决策过程以及减轻决策过程中冲突或不确定性的方法。
确定是否要为孩子割礼的准父母中存在或不存在决策冲突，并确定这种冲突的决定因素，以指导未来的教育措施。
使用便利抽样法招募在产科诊所就诊的父母以及通过机构电子邮件联系的父母，并让他们填写经过验证的决策冲突量表（DCS）。通过机构电子邮件招募了一小部分受试者，让他们完成关于决策过程的半结构化访谈，特别是对决策的不确定性。使用描述性统计和未配对 t 检验分析调查数据。对于访谈数据，使用迭代的、基于理论的方法。
173 名受试者完成了 DCS。所有参与者中有 12%的人存在高度决策冲突。直观地说，那些尚未决定是否割礼的人具有最高比例的高 DCS（69%），其次是那些决定割礼的人（9.3%）和那些决定不割礼的人（1.7%）。对 24 名受试者进行了访谈，并根据他们的 DCS 分数和访谈回答，将他们分为低、中、高冲突组。出现了三个主要主题，将高冲突组与低冲突组区分开来。在对知识和信息获取的感觉、特定价值观的重要性以及这些价值观在决策中的作用的清晰程度以及支持决策的感觉方面，受试者之间存在明显差异。这些主题被用来创建一个视觉模型，描绘每个决策者的个体需求（图 1）。
这项研究强调了为父母提供决策支持的必要性，这种支持不仅基于信息，还注重价值观的清晰性和支持性决策。这项研究为创建针对个体需求的共同决策工具提供了一个起点。这项研究的局限性在于单一机构的设计和同质人群，因此在设计材料时，可能会发现其他未被识别的需求。
一小部分准父母在为他们的新生儿男孩割礼的决定上确实存在很大的不确定性。父母的需求包括感觉信息灵通、感觉得到支持和澄清与问题相关的重要价值观。
