Shared decision-making for pediatric elective penile surgery

Authors

  • Wyatt MacNevin Faculty of Medicine, Dalhousie University, Halifax, Nova Scotia, Canada https://orcid.org/0000-0002-6418-625X
  • Amanda MacDonald Faculty of Medicine, Dalhousie University, Halifax, Nova Scotia, Canada
  • Paul Hong Division of Otolaryngology - Head and Neck Surgery, Dalhousie University, Halifax, Nova Scotia, Canada
  • Dawn L. MacLellan Division of Pediatric Urology, IWK Health Centre, Halifax, Nova Scotia, Canada,
  • Peter A. Anderson Division of Pediatric Urology, IWK Health Centre, Halifax, Nova Scotia, Canada
  • Rodrigo L. P. Romao Division of Pediatric Urology, IWK Health Centre, Halifax, Nova Scotia, Canada

DOI:

https://doi.org/10.5489/cuaj.7761

Keywords:

Pediatric Urology, Shared Decision Making, Decisional Conflict, Penile, Circumcision, Hypospadias

Abstract

Introduction: In pediatric surgery, proxy decision-makers are frequently involved in treatment planning and may experience decisional conflict (DC). Shared decision-making (SDM) approaches may be effective to remedy DC. This study investigates DC and SDM involvement in elective pediatric penile surgery.

Methods: Forty-four parents of children aged <8 years undergoing elective penile surgery consultations at a tertiary pediatric hospital were prospectively enrolled. Patient and physician questionnaires were used to assess the SDM process and the SURE (Sure of myself; Understand information; Risk-benefit ratio; Encouragement) screening test was used to assess DC.

Results: Thirty-seven (84.1%) mothers and seven (15.9%) fathers were enrolled for circumcision (n=33, 75.0%) and distal hypospadias repair (n=11, 25.0%) consultations, with 21 (47.7%) choosing to proceed with surgery. Seven (15.9%) participants experienced clinically significant DC. Participant gender was not associated with higher levels of DC (p=0.318). The average patient and physician SDM scores were 88.2±10.0 and 85.3±7.4, respectively, with no correlation found between participant and physician perception of SDM involvement (p=0.168, p=0.276). DC was significantly associated with lower participant and physician ratings of SDM.

Conclusions: There was a high perception of SDM involvement by both parents and pediatric urologists regarding elective penile surgery. Of the 15% of parents experiencing DC, there was an association with lower participant and physician levels of SDM involvement. Despite high SDM scores overall, discrepancies exist between the perceived physician and participant SDM involvement.

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Published

2022-05-20

How to Cite

MacNevin, W., MacDonald, A., Hong, P., MacLellan, D. L., Anderson, P. A., & Romao, R. L. P. (2022). Shared decision-making for pediatric elective penile surgery. Canadian Urological Association Journal, 16(10). https://doi.org/10.5489/cuaj.7761

Issue

Section

Original Research