Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins University, Baltimore, Maryland, USA.
Department of Medicine, Johns Hopkins University, Baltimore, Maryland, USA.
Otolaryngol Head Neck Surg. 2024 Feb;170(2):552-559. doi: 10.1002/ohn.549. Epub 2023 Oct 9.
We characterize clinician information-sharing and parent verbal engagement during pediatric adenotonsillectomy consultations and evaluate whether these behaviors relate to disease-specific knowledge for parents of children with obstructive sleep-disordered breathing (OSDB).
Mixed-methods sequential explanatory analysis.
Outpatient otolaryngology clinics.
We analyzed audio-recorded communication during outpatient encounters for children undergoing initial evaluation for adenotonsillectomy. We identified discrete triadic instances of clinician discussion of individual risks and benefits, parent verbal responses coded as passive ("Right") or active ("Would that repeat the recovery time?"), and corresponding parent answer (correct or incorrect) on a postconsult knowledge questionnaire. Primary outcomes included parent knowledge and decisional conflict. We qualitatively analyzed substantive questions asked by parents during the encounter.
In 30 consults, clinicians (n = 8) provided 156 instances of discussion (101 risk, 55 benefit), to which parents provided 34% active responses. Clinician discussion of risks and benefits was associated with greater parent knowledge (odds ratio [OR] = 3.70, 95% confidence interval [CI]: 2.25-6.09; P < .001), however parent active engagement was not associated with greater parent knowledge (OR = 1.04, 95% CI: 0.42-2.58, P = .93). Parents demonstrated greater knowledge of benefits than risks (χ = 23.16, V = 1.13; P < .001). Parents who responded actively (OR = 0.26, 95% CI: 0.09-0.72; P = .010) or had greater knowledge (OR = 0.41, 95% CI: 0.21-0.81; P = .010) had less decisional conflict.
Clinician information-sharing was associated with greater parent knowledge about OSDB treatment. Greater parent engagement and knowledge were independently associated with less decisional conflict. These findings may inform clinicians' approaches to counseling and engaging parents in decisions for surgery.
我们描述了儿科腺样体扁桃体切除术咨询期间临床医生的信息共享和家长的口头参与情况，并评估了这些行为是否与患有阻塞性睡眠呼吸障碍（OSDB）儿童的父母的特定疾病知识有关。
混合方法顺序解释分析。
门诊耳鼻喉科诊所。
我们分析了接受腺样体扁桃体切除术初始评估的儿童门诊就诊期间的录音交流。我们确定了临床医生讨论个体风险和益处的离散三元实例，父母口头反应编码为被动（“正确”）或主动（“那会重复恢复期吗？”），以及相应的父母在咨询后知识问卷上的回答（正确或不正确）。主要结果包括父母的知识和决策冲突。我们对父母在咨询期间提出的实质性问题进行了定性分析。
在 30 次咨询中，临床医生（n=8）提供了 156 个讨论实例（101 个风险，55 个益处），家长提供了 34%的主动反应。临床医生讨论风险和益处与父母知识增加相关（比值比[OR] = 3.70，95%置信区间[CI]：2.25-6.09；P<.001），然而，父母的积极参与与父母知识的增加无关（OR = 1.04，95% CI：0.42-2.58，P=.93）。父母对益处的了解比对风险的了解更多（χ²=23.16，V=1.13；P<.001）。积极回应的父母（OR=0.26，95% CI：0.09-0.72；P=.010）或知识更丰富的父母（OR=0.41，95% CI：0.21-0.81；P=.010）的决策冲突较小。
临床医生的信息共享与父母对 OSDB 治疗的了解程度增加有关。父母的更多参与和知识与较少的决策冲突独立相关。这些发现可能为临床医生的咨询方法提供信息，并使父母参与手术决策。
