UP-126 Shared decision making for pediatric elective penile surgery
Thursday June 27, 2019 from

Wyatt MacNevin, Canada

Research Assistant

Faculty of Medicine

Dalhousie Medical School


Shared decision making for pediatric elective penile surgery

Wyatt MacNevin1, Amanda MacDonald1, Paul Hong2, Dawn L. MacLellan3,4, Peter A. Anderson3,4, Rodrigo Romao3,4.

1Faculty of Medicine, Dalhousie University, Halifax, NS, Canada; 2Division of Otolaryngology, Dalhousie University, Halifax, NS, Canada; 3Division of Pediatric Urology, IWK Health Centre, Halifax, NS, Canada; 4Department of Urology, Dalhousie University, Halifax, NS, Canada

Parents act as substitute decision-makers for children undergoing elective surgical treatment, which can lead to decisional conflict (DC). To remedy DC, collaborative shared decision making (SDM) approaches between physicians and proxy decision-makers may be effective. This study investigates DC and the perception of SDM in elective penile surgery.

Forty-four parents of children aged < 8 years undergoing consultation for elective penile surgery at a tertiary pediatric hospital were prospectively enrolled. The SDM process was assessed using SDM-Q-9 (Patient) and SDM-Q-Doc (Physician) questionnaires and DC was assessed using the SURE screening test. Statistical analysis was performed to determine the relationship between SDM and DC.

Participants included 37 (82.2%) women and 7 (15.6%) men. Participants underwent consultation for circumcision (n = 33, 75.0%) and distal hypospadias repair (n = 11, 25.0%) with 21 (47.7%) participants choosing to proceed with surgery. Seven (15.9%) participants experienced significant DC. Participant sex and surgery type was not associated with participants experiencing DC (p = 0.318, p = 0.475). The average SDM-Q-9 and SDM-Q-Doc scores were 88.2 ± 10.0 and 85.3 ± 7.4 respectively, with spearman correlation analysis showing no relationship between participant and physician perception of SDM involvement (r = 0.168, p = 0.276). Lower participant (SDM-Q-9: 81.7 ± 5.8, p = 0.023) and physician (SDM-Q-Doc: 79.9 ± 6.9, p = 0.029) ratings of SDM were significantly associated with DC.

Both parents and pediatric urologists perceived a high degree of SDM pertaining to elective penile surgery in children. In about half the cases a decision was made to proceed with surgery; only 15% of parents experienced DC, which was associated with lower participant and physician perceived SDM involvement. Despite high SDM scores overall, discrepancies exist between the perceived physician and participant involvement in the SDM process.

Lectures by Wyatt MacNevin

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