The Barriers and Facilitators of Shared Decision Making in Pediatric Otolaryngology: A Qualitative Study.

IF 2.6 3区 医学 Q1 OTORHINOLARYNGOLOGY Otolaryngology- Head and Neck Surgery Pub Date : 2024-10-03 DOI:10.1002/ohn.972
Usman Khan, Erin Luther, Christine E Cassidy, Emily Boss, Kara D Meister, Lauren Bohm, M Elise Graham, Paul Hong
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Abstract

Objective: To identify barriers and facilitators to implementing shared decision making (SDM) in pediatric otolaryngology.

Study design: A qualitative study.

Setting: Semistructured interviews of pediatric otolaryngologists.

Methods: The Theoretical Domains Framework (TDF) was used as a guide for data collection and analysis to consider capability, opportunity, and motivation (COM-B) factors. The focal surgical procedures were tonsillectomy, adenoidectomy, and tympanostomy tube placement. Deductive and inductive coding of interview transcripts according to TDF/COM-B domains were performed by 2 separate reviewers.

Results: A total of 11 interviews were conducted to achieve data saturation. The 4 dominant themes were: (1) inconsistent inclusion of SDM elements in practice, (2) social influences from parents, (3) environmental context, and (4) applicability of SDM in otolaryngology. Theme 1 identified that surgeons perceived SDM as a feature of their practice. However, the discussion of parents' values was seen as less explicit and structured interview formats were not commonly employed. Theme 2 demonstrated that surgeons saw parents' preconsult "agenda" as influencing their openness to consider multiple treatment options. Theme 3 pointed to the barriers of short appointment times, challenges in the use of support staff and lack of decision aids. Theme 4 emphasized surgeons' belief in the value of SDM and that parents' involvement in decision making reduced likelihood of decisional regret.

Conclusion: Pediatric otolaryngologists strongly support the value of SDM during clinical encounters, particularly to allow parent ownership of decisions regarding treatment. The major barriers were lack of clinical translation of SDM knowledge, social influences, and environmental factors.

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小儿耳鼻喉科共同决策的障碍和促进因素:定性研究。
研究目的研究设计:一项定性研究:定性研究:对儿科耳鼻喉科医生进行半结构式访谈:采用理论领域框架(TDF)作为数据收集和分析的指南,考虑能力、机会和动机(COM-B)因素。重点手术程序为扁桃体切除术、腺样体切除术和鼓室造口术置管术。根据 TDF/COM-B 领域对访谈记录进行演绎和归纳编码,分别由两名审阅者完成:共进行了 11 次访谈以达到数据饱和。4 个主导主题是(1) 在实践中纳入 SDM 要素的不一致性,(2) 来自父母的社会影响,(3) 环境背景,以及 (4) SDM 在耳鼻喉科的适用性。主题 1 指出,外科医生认为 SDM 是其实践的一个特点。然而,对家长价值观的讨论并不明确,结构化访谈形式也不常用。主题 2 表明,外科医生认为家长在就诊前的 "议程 "影响了他们考虑多种治疗方案的开放性。主题 3 指出了预约时间短、使用辅助人员方面的挑战以及缺乏决策辅助工具等障碍。主题 4 强调外科医生相信 SDM 的价值,并认为家长参与决策可降低决策后悔的可能性:结论:小儿耳鼻喉科医生强烈支持在临床诊疗过程中开展 SDM,尤其是让家长自主决定治疗方案。主要障碍是缺乏 SDM 知识的临床转化、社会影响和环境因素。
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来源期刊
Otolaryngology- Head and Neck Surgery
Otolaryngology- Head and Neck Surgery 医学-耳鼻喉科学
CiteScore
6.70
自引率
2.90%
发文量
250
审稿时长
2-4 weeks
期刊介绍: Otolaryngology–Head and Neck Surgery (OTO-HNS) is the official peer-reviewed publication of the American Academy of Otolaryngology–Head and Neck Surgery Foundation. The mission of Otolaryngology–Head and Neck Surgery is to publish contemporary, ethical, clinically relevant information in otolaryngology, head and neck surgery (ear, nose, throat, head, and neck disorders) that can be used by otolaryngologists, clinicians, scientists, and specialists to improve patient care and public health.
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