Jones Anna, Mangadu Aparna, Dallas Sarah, Hanson Olivia, Arn Katherine, Gesteland Per, Szymczak Julia E, Pavia Andrew T, Leung Daniel T, Watt Melissa H
Department of Pediatrics, University of Utah School of Medicine, Salt Lake City.
Division of Infectious Disease, Department of Internal Medicine, University of Utah School of Medicine, Salt Lake City.
JAMA Netw Open. 2025 Sep 2;8(9):e2531000. doi: 10.1001/jamanetworkopen.2025.31000.
Advances in diagnostics have enabled the detection of more gastrointestinal pathogens, but misuse of diagnostics can lead to inappropriate antibiotic use and excess financial burdens. Ensuring appropriate use of diagnostics is crucial for optimizing patient care and promoting stewardship of health care resources.
To elicit parents' and clinicians' perspectives on expectations for care of pediatric diarrhea with a focus on diagnostic testing and to evaluate the potential for an electronic clinical decision support tool (ECDST) to improve appropriate use of diagnostics.
DESIGN, SETTING, AND PARTICIPANTS: In this qualitative study, purposeful sampling was used to recruit parents of children who had sought care for diarrhea and clinicians who care for children with diarrhea from 5 urgent care sites and 1 emergency department in Utah. Recruitment ended after achievement of inductive thematic saturation. Participants were interviewed between June 15, 2023, and January 24, 2025.
Key themes on expectations for management of pediatric diarrhea and perceptions of an ECDST. Interviews elicited expectations for diagnostic testing and treatment of pediatric diarrhea as well as the perceived utility of an ECDST. Analysis followed an applied thematic analysis framework.
Forty-four parents (40 [91%] female; median age, 34 years [range, 21-47 years]) and 16 clinicians (11 [69%] female; median age, 42 years [range, 29-59 years]) were interviewed. Three motivators were identified for parents to seek clinical care for a child with diarrhea: (1) reassurance, (2) understanding the cause of symptoms, and (3) appropriate treatment. Parents viewed diagnostic testing as a tool for meeting these expectations. Clinicians expressed skepticism for the value of diagnostics in informing etiology or treatment but reported that they may order diagnostics to reassure parents. Many clinicians acknowledged the benefits of an ECDST to assist with evidence-based decision-making for diagnostics and facilitate communication with families.
This qualitative study identified both similarities and tensions between parents and clinicians in expectations for pediatric diarrhea care, especially pertaining to the role of diagnostics. The findings suggest that strategies such as the use of ECDSTs are needed to resolve tension in care expectations, facilitate diagnostic stewardship, and optimize care for pediatric diarrhea.
诊断技术的进步使得能够检测出更多的胃肠道病原体，但诊断技术的滥用可能导致不恰当的抗生素使用和额外的经济负担。确保诊断技术的合理使用对于优化患者护理和促进医疗资源的管理至关重要。
了解家长和临床医生对小儿腹泻护理的期望，重点关注诊断测试，并评估电子临床决策支持工具（ECDST）改善诊断技术合理使用的潜力。
设计、地点和参与者：在这项定性研究中，采用目的抽样法从犹他州的5个紧急护理点和1个急诊科招募腹泻患儿的家长以及照顾腹泻患儿的临床医生。在达到归纳主题饱和后结束招募。参与者在2023年6月15日至2025年1月24日期间接受了访谈。
小儿腹泻管理期望和对ECDST认知的关键主题。访谈引出了对小儿腹泻诊断测试和治疗的期望以及对ECDST的感知效用。分析遵循应用主题分析框架。
采访了44名家长（40名[91%]为女性；中位年龄34岁[范围21 - 47岁]）和16名临床医生（11名[69%]为女性；中位年龄42岁[范围29 - 59岁]）。确定了家长为腹泻患儿寻求临床护理的三个动机：（1）安心，（2）了解症状原因，（3）适当治疗。家长将诊断测试视为满足这些期望的工具。临床医生对诊断在告知病因或治疗方面的价值表示怀疑，但报告称他们可能会开具诊断测试以安抚家长。许多临床医生承认ECDST有助于基于证据进行诊断决策并促进与家庭的沟通。
这项定性研究确定了家长和临床医生在小儿腹泻护理期望方面的异同之处，特别是在诊断的作用方面。研究结果表明，需要诸如使用ECDST等策略来解决护理期望方面的紧张关系，促进诊断管理，并优化小儿腹泻的护理。
