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Decision-making in Pediatric Plastic Surgery: Autonomy Versus Shared Approaches

Ranganathan, Kavitha MD; Luby, Alexandra O. MS; Haase, Madeleine; Patterson, Anne; Buchman, Steven R. MD; Waljee, Jennifer F. MD

Plastic and Reconstructive Surgery - Global Open: August 2019 - Volume 7 - Issue 8S-1 - p 58-59
doi: 10.1097/01.GOX.0000584540.87669.7a
Craniofacial Abstracts
Best Abstract

University of Michigan, Ann Arbor, MI

This is an open-access article distributed under the terms of the Creative Commons Attribution-Non Commercial-No Derivatives License 4.0 (CCBY-NC-ND), where it is permissible to download and share the work provided it is properly cited. The work cannot be changed in any way or used commercially without permission from the journal.

BACKGROUND: Although shared decision-making is an essential component of patient-centered healthcare, its role in pediatric patient populations is not well-defined. Particularly among children presenting to pediatric plastic surgery clinics, the extent of agreement among parents, children, and providers regarding the extent of autonomous decision-making remains unclear. The goal of the present study was to define the preferred level of autonomy in decision-making among the various stakeholders involved in cleft care.

METHODS: We surveyed children presenting to plastic surgery clinics (n = 100) and their caregivers regarding their preferences on autonomy during the process of surgical decision-making. Patients and their parents independently completed surveys on their preferred method of decision-making and autonomy. Fleiss’ kappa was used to assess the extent of agreement between groups. Bivariate chi-square tests were used to assess the relationship between decision-making preferences and demographic factors such as age, gender, and socioeconomic status. Multinomial logistic regression was performed to assess the relationship between age and sex and child/parent preference.

RESULTS: Of the 100 children surveyed, 64 were female; the average age was 12.5 years. Children and their caregivers disagreed upon their overall decision-making preferences (k = 0.0385). Overall, 40% of children and 67% of parents preferred the option of completely shared decision-making among the patient, parent, and provider; the minority of children (16%) preferred the doctor to be the sole decision-maker. Approximately 20% of children desired complete autonomy. Child’s preference was significantly associated with their age; the relative risk of children deferring to parents or surgeons over a shared approach was lower for adolescents compared to children under 10 years old (RR, 0.202; 95% confidence interval, 0.054–0.751; P = 0.017). Alternatively, caregiver’s preferences did not change based on the child’s age, but rather based on the child’s sex. Parents were less likely to prefer a shared approach when the child was female (odds ratio, 0.365; 95% confidence interval, 0.139–0.961; P = 0.04).

CONCLUSIONS: Although most parents preferred a completely shared approach to decision-making, children desired greater autonomy, particularly with increasing age. There was limited agreement between parents and children regarding their decision-making preferences. Providers must be cognizant of differing preferences among parents and children when discussing treatment plans and surgical algorithms; to optimize patient and parent satisfaction, differing methods of discussion may be required to respect the preferences of all stakeholders involved.

Copyright © 2019 The Authors. Published by Wolters Kluwer Health, Inc. on behalf of The American Society of Plastic Surgeons. All rights reserved.