Physicians' Perspectives on Presurgical Discussion and Shared Decision-Making in Pediatric Epilepsy Surgery.
Physicians' Perspectives on Presurgical Discussion and Shared Decision-Making in Pediatric Epilepsy Surgery.
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DOI：
10.1177/08830738221089472
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发表时间：
2022-04
影响因子：
1.9
通讯作者：
Curran GM
中科院分区：
文献类型：
--
作者：
Samanta D;Ostendorf AP;Singh R;Gedela S;Elumalai V;Hoyt ML;Perry MS;Bartolini L;Curran GM
定性探讨小儿癫痫医生在癫痫手术方案咨询时的方法，介绍手术的风险和益处，克服手术阻力，促进与患者和家属共同决策。我们对一家四级小儿癫痫中心的11名学术临床医生（5名神经科医生，5名癫痫科医生，1名神经外科医生）进行了深入访谈，以探讨医生如何沟通和追求手术决策。混合归纳演绎分析揭示了手术前讨论的三个关键主题（及其副主题）：(1)癫痫手术的候选人选择和初步讨论（神经科医生与癫痫医生的比较，讨论的时间，不情愿的家庭）(2)详细的癫痫手术个性化咨询(共同决策[促成因素和障碍]和风险-收益分析[平衡风险和收益，统计效益估计，关于SUDEP的讨论，对认知和行为结果的预测，(3)改进决策的工具（针对患者和家庭的教育干预以及针对提供者和组织的干预）。治疗癫痫的医生术前讨论缺乏一致性。尽管人们普遍对合作决策感兴趣，但专家们提出了以下问题的担忧：缺乏沟通培训和优化决策的临床工具，大量家庭不觉得有能力分享决策，将决策完全交给医生，以及缺乏个性化风险-收益咨询的实用资源。应制定临床实践指南，以减少手术前咨询中现有的实践差异。关于何时以及如何启动关于癫痫手术的对话，讨论的基本组成部分，以及利用各种工具来提高癫痫手术的利用率，需要进一步达成共识。
To qualitatively explore the approach of pediatric epilepsy providers when counseling regarding surgical options for epilepsy, presenting risks and benefits of surgery, overcoming resistance to surgery, and fostering shared decision making with patients and families. We conducted in-depth interviews with 11 academic clinicians (5- neurologists, 5-epileptologists, 1- neurosurgeon) from a Level 4 pediatric epilepsy center to explore how physicians communicate and pursue surgical decision-making. A blended inductive-deductive analysis revealed three key themes (with subthemes) of presurgical discussions: (1) Candidate selection and initial discussion about epilepsy surgery (neurologists compared to epileptologists, the timing of the discussion, reluctant families) (2) Detailed individualized counseling about epilepsy surgery (shared decision-making [enablers and barriers] and risk-benefit analysis [balancing risks and benefits, statistical benefit estimation, discussion about SUDEP, prognostication about cognitive and behavioral outcomes, risks of surgery]) (3) Tools to improve decision-making (educational interventions for patients and families and provider- and organization-specific interventions). Presurgical discussions lack uniformity among physicians who treat epilepsy. Despite general interest in collaborative decision-making, experts raised concern about lack of exposure to communication training and clinical tools for optimizing decision-making, a high number of families who do not feel equipped to share the decision making leaving the decision-making entirely to the physician, and paucity of practical resources for individualized risk-benefit counseling. Clinical practice guidelines should be developed to reduce existing practice variations in presurgical counseling. Further consensus is needed about when and how to initiate the conversation about epilepsy surgery, essential components of the discussion, and the utility of various tools to improve the utilization of epilepsy surgery.
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影响因子：
3.2
作者：
Hsieh, HF;Shannon, SE
通讯作者：
Shannon, SE
DOI：
10.1186/1748-5908-4-50
发表时间：
2009-08-07
期刊：
Implementation science : IS
影响因子：
--
作者：
Damschroder LJ;Aron DC;Keith RE;Kirsh SR;Alexander JA;Lowery JC
通讯作者：
Lowery JC
影响因子：
3.1
作者：
Engelhart, Marsha C. J. M.;van Schooneveld, Monique M. J.;van Nieuwenhuizen, Onno
通讯作者：
van Nieuwenhuizen, Onno
影响因子：
2.6
作者：
Choi, Hyunmi;Pargeon, Kim;Bakken, Suzanne
通讯作者：
Bakken, Suzanne
影响因子：
14.5
作者：
Berg, Anne T.;Mathern, Gary W.;Levy, Susan R.
通讯作者：
Levy, Susan R.