探讨在急诊科就诊的 90 天以下发热婴儿的临床医生和家长的沟通偏好和风险阈值：一项定性研究。
Exploring communication preferences and risk thresholds of clinicians and parents of febrile infants under 90 days presenting to the emergency department: a qualitative study.
机构信息
Wellcome Wolfson Institute for Experimental Medicine, Queen's University Belfast School of Medicine, Dentistry and Biomedical Sciences, Belfast, UK
Royal Belfast Hospital for Sick Children, Belfast, UK.
出版信息
Arch Dis Child. 2024 Oct 18;109(11):886-893. doi: 10.1136/archdischild-2023-326727.
BACKGROUND
Febrile infants under 3 months of age are at higher risk of invasive bacterial illness (IBI) when compared with older children. Increasingly sequential assessment based on age, clinical appearance and biomarkers is used to determine the risk of IBI, and appropriateness of invasive procedures such as lumbar puncture. The purpose of this qualitative study is to report parents and clinicians' opinions on communication of risks and benefits of sequential assessment and tailored treatment.
METHODS
18 parents enrolled in the Febrile Infant Diagnostic Assessment and Outcomes study and seven clinicians from England, Wales and Northern Ireland were purposively selected to participate in virtual qualitative interviews. Data were analysed thematically.
RESULTS
Tailored treatment plans were widely supported. Confidence in the clinician was central to parents' attitude towards management recommendations. Parents' decision-making preferences change throughout their child's clinical journey, with an initial preference for clinician-led decisions evolving towards collaborative decision-making as their stress and anxiety reduce. There were widespread differences in preferences for how risk was discussed. Parents self-reported poor retention of information and felt communication adjuncts helped their understanding. Clinicians were generally positive about the use of clinical decision aids as a communication tool, rather than relying on them for decision-making.
DISCUSSION
Parents want to feel informed, but their desire to be involved in shared decision-making evolves over time.Clinicians appear to use their clinical judgement to provide individualised information, evolving their communication in response to perceived parental needs.Poor information retention highlights the need for repetition of information and use of communication adjuncts.
TRIAL REGISTRATION NUMBER
NCT05259683.
背景
与年长儿童相比，3 个月以下发热婴儿发生侵袭性细菌病（IBI）的风险更高。越来越多的人根据年龄、临床特征和生物标志物进行序贯评估，以确定 IBI 的风险以及腰椎穿刺等侵入性操作的适当性。本定性研究的目的是报告父母和临床医生对序贯评估和针对性治疗的风险和获益沟通的意见。
方法
18 名参加发热婴儿诊断评估和结局研究的父母和来自英格兰、威尔士和北爱尔兰的 7 名临床医生被有目的地选择参加虚拟定性访谈。对数据进行主题分析。
结果
量身定制的治疗计划得到了广泛支持。父母对管理建议的态度主要取决于对临床医生的信任。父母的决策偏好会随着孩子的临床治疗过程而改变，最初倾向于由临床医生主导的决策，随着他们的压力和焦虑减轻，逐渐转变为协作决策。对于如何讨论风险，存在广泛的偏好差异。父母自述对信息的保留能力较差，并认为沟通辅助工具有助于他们理解。临床医生普遍对使用临床决策辅助工具作为沟通工具持积极态度，而不是依赖这些工具做出决策。
讨论
父母希望感到知情，但他们对共同决策的参与愿望会随着时间的推移而发展。临床医生似乎根据他们的临床判断提供个性化信息，并根据感知到的父母需求调整他们的沟通方式。信息保留能力差突出了重复信息和使用沟通辅助工具的必要性。
试验注册号
NCT05259683。
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