Khan Usman, Luther Erin, Cassidy Christine E, Boss Emily, Meister Kara D, Bohm Lauren, Elise Graham M, Hong Paul
Division of Otolaryngology-Head and Neck Surgery, Dalhousie University, Halifax, Nova Scotia, Canada.
Department of Surgery, IWK Health Centre, Halifax, Nova Scotia, Canada.
Otolaryngol Head Neck Surg. 2025 Jan;172(1):273-282. doi: 10.1002/ohn.972. Epub 2024 Oct 3.
To identify barriers and facilitators to implementing shared decision making (SDM) in pediatric otolaryngology.
A qualitative study.
Semistructured interviews of pediatric otolaryngologists.
The Theoretical Domains Framework (TDF) was used as a guide for data collection and analysis to consider capability, opportunity, and motivation (COM-B) factors. The focal surgical procedures were tonsillectomy, adenoidectomy, and tympanostomy tube placement. Deductive and inductive coding of interview transcripts according to TDF/COM-B domains were performed by 2 separate reviewers.
A total of 11 interviews were conducted to achieve data saturation. The 4 dominant themes were: (1) inconsistent inclusion of SDM elements in practice, (2) social influences from parents, (3) environmental context, and (4) applicability of SDM in otolaryngology. Theme 1 identified that surgeons perceived SDM as a feature of their practice. However, the discussion of parents' values was seen as less explicit and structured interview formats were not commonly employed. Theme 2 demonstrated that surgeons saw parents' preconsult "agenda" as influencing their openness to consider multiple treatment options. Theme 3 pointed to the barriers of short appointment times, challenges in the use of support staff and lack of decision aids. Theme 4 emphasized surgeons' belief in the value of SDM and that parents' involvement in decision making reduced likelihood of decisional regret.
Pediatric otolaryngologists strongly support the value of SDM during clinical encounters, particularly to allow parent ownership of decisions regarding treatment. The major barriers were lack of clinical translation of SDM knowledge, social influences, and environmental factors.
确定在小儿耳鼻咽喉科实施共同决策（SDM）的障碍和促进因素。
一项定性研究。
对小儿耳鼻咽喉科医生进行半结构化访谈。
以理论领域框架（TDF）为数据收集和分析的指南，以考虑能力、机会和动机（COM-B）因素。重点手术包括扁桃体切除术、腺样体切除术和鼓膜置管术。由两名独立的评审员根据TDF/COM-B领域对访谈记录进行演绎和归纳编码。
共进行了11次访谈以达到数据饱和。4个主要主题为：（1）在实践中SDM要素的纳入不一致，（2）来自家长的社会影响，（3）环境背景，以及（4）SDM在耳鼻咽喉科的适用性。主题1表明外科医生将SDM视为其实践的一个特征。然而，对家长价值观的讨论被认为不够明确，且未普遍采用结构化访谈形式。主题2表明外科医生认为家长咨询前的“议程”会影响他们对多种治疗选择的接受程度。主题3指出了预约时间短的障碍、使用辅助人员方面的挑战以及缺乏决策辅助工具。主题4强调了外科医生对SDM价值的信念，以及家长参与决策可降低决策后悔的可能性。
小儿耳鼻咽喉科医生强烈支持在临床诊疗过程中SDM的价值，特别是让家长对治疗决策拥有自主权。主要障碍包括SDM知识缺乏临床转化、社会影响和环境因素。
