Parents’ experiences of treatment and outcomes in high-grade vesicoureteral reflux in infants – One piece in the puzzle of VUR management?

Introduction

Countless papers have been published regarding the management and clinical outcome of vesicoureteral reflux (VUR), still no active treatment has been proven superior to another, regarding preserving renal function. When considering comparable treatment alternatives, qualitative research is needed to understand the parents’ perspectives and preferences.

Objective

This study aims to describe the parents’ experiences of infant high-grade VUR (hVUR) regarding continuous antibiotic prophylaxis (CAP), surgical intervention (SI), urinary tract infection (UTI) and renal damage.

Materials and methods

We performed four randomized, semi-structured focus groups (FG) with 19 parents to 15 children (aged 1,5–6 years). All children had been diagnosed with hVUR at <8 months of age and treated with CAP (all groups) and SI (two groups). Discussions were recorded, transcribed and analysed to content. The sample size for the FGs was based on category saturation, which was confirmed through comparison analysis in multiple FGs.

Results

The FGs generated 2,897 parent-reported experiences, of which this study reports on 1,123, sorted into the abovementioned four themes and underlying categories. Negative experiences regarding CAP, such as stress regarding the daily intake and worries about long-term use and side effects, were abundant, whereas positive experiences were few. The experiences regarding SI were negatively affected by inadequate information and postoperative difficulties and positively by empathy, accurate information and adequate preparations. The increased risk of UTIs were described as a constant emotional stress causing restricted social activities, frequent visits to the hospital and challenges regarding urine-sampling. There was a common awareness of renal damage, but few experiences reflected any actual worry.

Discussion

The daily struggle with medications and monitoring for symptoms, concerns of future antibiotic resistance and a parental preference of SI have been documented in previous studies. FG methodology effectively collects data from several participants during the same occasion, the goal being to generate discussions that enable researchers to see the world from the participants’ perspective. Since the management of infants with hVUR is still under debate, qualitative research can remind of valuable patient and parent perspectives.

Conclusion

This study shows that CAP and the risk of UTI have non-negligible, everyday impact on family life, while renal damage seems of secondary importance. The concerns of surgical treatment are related to an isolated occasion, which can be optimized with proper care and improved preoperative preparations. Awareness of parents’ experiences and preferences is helpful when managing children with hVUR.

Summary table.

Themes and categories	n = 1123 statements
Parents' experiences of continuous antibiotic prophylaxis, CAP	n=320
Emotional impact	n = 140 (44%)
Concerns about the effect of CAP	n = 96 (30%)
Influence of CAP intake	n = 84 (26%)
Parents' experiences of surgical intervention, SI	n=182
Difficulties in surgical care	n = 94 (52%)
Qualities in surgical care	n = 88 (48%)
Parents' experiences of urinary tract infection (UTI)	n=535
Family impact due to the child's UTI	n = 273 (51%)
Emergency care at suspected UTI of the child	n = 131 (24%)
Obstacles and facilitators of sampling and testing of urine	n = 131 (24%)
Parents' experiences of renal damage	n=86
Risk of renal damage	n = 86 (100%)