Parental perspectives on decision-making about hypospadias surgery
Parental perspectives on decision-making about hypospadias surgery
复制标题
DOI：
10.1016/j.jpurol.2019.04.017
复制
发表时间：
2019-10-01
影响因子：
2
通讯作者：
Frankel, R.
中科院分区：
文献类型：
--
作者：
Chan, K. H.;Panoch, J.;Frankel, R.
许多父母选择尿道下裂修复他们的儿子经历决策冲突和遗憾。利用共同的决策过程可以解决尿道下裂修复中的决策冲突和后悔问题，通过让父母和医生参与决策。研究设计我们进行了半结构化的访谈，对患有尿道下裂的儿童的父母进行了访谈，尿道下裂探讨他们作为代理决策者的作用，询问他们的情绪/关注，信息需求和外部/内部影响。访谈进行，直到没有新的主题被确定，分析他们反复使用开放，轴向和选择性编码。迭代方法需要在数据收集过程中进行访谈和分析记录的循环过程。这使得研究人员可以根据初步数据分析对访谈指南进行必要的调整，以探索早期与父母访谈中出现的主题。扎根理论的方法被用来开发一个解释的手术决策process.Results16母亲和一个父亲的7术前和9术后患者（n = 16）与远端（8）和近端（8）耳道位置进行了采访。确定了手术决策过程的四个阶段：（1）处理诊断，（2）综合信息，（3）处理情绪和担忧，（4）最终决定（扩展汇总图）。确定了决策过程每个阶段的核心概念。主要问题包括对儿童无法从麻醉中醒来的焦虑/恐惧以及他们无法出现在手术室。父母纳入信息从互联网上，医疗服务提供者，和他们的社交网络，因为他们试图减轻困惑和焦虑，同时建立信任/信心，在他们的孩子的surgeon.DiscussionThe研究结果有助于我们了解尿道下裂手术的决策是一个复杂的和多方面的过程。总体小样本量是典型的，预期用于定性研究。这项研究的主要局限性，但是，是代表性不足的父亲，少数民族，和同性couples.ConclusionsThis研究提供了一个初步的框架，父母的决策过程尿道下裂手术，将告知决策援助的发展。决策援助发展的未来阶段将侧重于招募父亲，少数民族和同性伴侣，以丰富我们工作的视角。
IntroductionMany parents who choose hypospadias repair for their son experience decisional conflict and regret. The utilization of a shared decision-making process may address the issue of decisional conflict and regret in hypospadias repair by engaging both parents and physicians in decision-making.ObjectiveThe objective of this study was to develop a theoretical framework of the parental decision-making process about hypospadias surgery to inform the development of a decision aid.Study designWe conducted semistructured interviews were conducted with parents of children with hypospadias to explore their role as proxy decision-makers, inquiring about their emotions/concerns, informational needs, and external/internal influences. Interviews were conducted until no new themes were identified, analyzing them iteratively using open, axial, and selective coding. The iterative approach entails a cyclical process of conducting interviews and analyzing transcripts while the data collection process is ongoing. This allows the researcher to make adjustments to the interview guide as necessary based on preliminary data analysis in order to explore themes that emerge from early interviews with parents. Grounded theory methods were used to develop an explanation of the surgical decision-making process.ResultsSixteen mothers and one father of seven preoperative and nine postoperative patients (n = 16) with distal (8) and proximal (8) meatal locations were interviewed. Four stages of the surgical decision-making process were identified: (1) processing the diagnosis, (2) synthesizing information, (3) processing emotions and concerns, and (4) finalizing the decision (Extended Summary Figure). Core concepts in each stage of the decision-making process were identified. Primary concerns included anxiety/fear about the child not waking up from anesthesia and their inability to be present in the operating room. Parents incorporated information from the Internet, medical providers, and their social network as they sought to relieve confusion and anxiety while building trust/confidence in their child's surgeon.DiscussionThe findings of this study contribute to our understanding of decision-making about hypospadias surgery as a complex and multifaceted process. The overall small sample size is typical and expected for qualitative research studies. The primary limitation of the study, however, is the underrepresentation of fathers, minorities, and same-sex couples.ConclusionsThis study provides an initial framework of the parental decision-making process for hypospadias surgery that will inform the development of a decision aid. Future stages of decision aid development will focus on recruitment of fathers, minorities, and same-sex couples in order to enrich the perspectives of our work.