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Mendez M, Panganiban K, Kieran K. Guess Who's Coming to Clinic? Companions in a Pediatric Urology Clinic. J Surg Res 2024; 297:144-148. [PMID: 38531117 DOI: 10.1016/j.jss.2024.01.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2023] [Revised: 12/30/2023] [Accepted: 01/16/2024] [Indexed: 03/28/2024]
Abstract
INTRODUCTION Understanding who accompanies children to clinic visits is necessary to engage stakeholders and tailor communication and educational materials. We undertook this study to describe the clinical companions for new patients in a general pediatric urology clinic. METHODS This retrospective cross-sectional study included all new urology patients aged less than 18 y at a single freestanding quaternary care children's hospital in selected months of 2019 and 2022. Data were collected on patient demographics, diagnosis, level of community disadvantage, and companion present. The number and identities of companions of patients living in more and less disadvantaged neighborhoods were compared. RESULTS Of 1940 patients, 1014 (52%) were accompanied by mothers alone, 266 (14%) by fathers alone, and 580 (30%) by both mother and father. Mothers were at 85% of clinical visits and fathers at 45% of visits. The likelihood of having one versus two parents present was similar in more and less disadvantaged areas (odds ratio [OR] = 1.11, 95% confidence interval: 0.80-1.55, P = 0.53). When one parent was present, the odds of being accompanied by the mother was lower for patients living in Area Deprivation Index 1-2 (less disadvantaged areas; OR = 0.38, 95% confidence interval: 0.23-0.62, P = 0.0001), and for the father to accompany children aged 12 y and more than infants (OR = 2.16, P = 0.0005) if there was only one parent present. CONCLUSIONS Our findings highlight opportunities to engage nonmaternal caregivers in pediatric urologic care, to further explore parental decisions around appointment attendance, and to optimize how clinical information is delivered to caregivers who are and are not present during appointments.
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Affiliation(s)
- Meridiana Mendez
- Division of Urology, Seattle Children's Hospital, Seattle, Washington
| | - Kurt Panganiban
- Division of Urology, Seattle Children's Hospital, Seattle, Washington
| | - Kathleen Kieran
- Division of Urology, Seattle Children's Hospital, Seattle, Washington; Department of Urology, University of Washington, Seattle, Washington.
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Binion KE, Perreira KM, Villa Torres L, White JT, Hernandez GC, Kaefer M, Misseri R, Ross S, Chan KH. A multi-site cultural and linguistic adaptation of a hypospadias decision aid for Latinx communities. J Pediatr Urol 2024:S1477-5131(24)00192-X. [PMID: 38688803 DOI: 10.1016/j.jpurol.2024.04.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2023] [Revised: 02/19/2024] [Accepted: 04/03/2024] [Indexed: 05/02/2024]
Abstract
INTRODUCTION Latinx, Spanish-speaking (LSS) patients are more likely to experience decisional conflict and regret about healthcare decisions than non-Hispanic, white, English-speaking patients. OBJECTIVE To adapt the Hypospadias Hub (Hub), a rigorously developed and tested web-based decision aid (DA), for LSS parents. METHODS Guided by the Ecological Validity Model (EVM), a heuristic framework was followed to culturally adapt the Hub (see Extended Summary Figure). In stage 1, recommendations were obtained from a focus group with members of the institution's Latinx Community Review Board (Latinx CRB) and semi-structured interviews with pediatricians with Latinx-focused practices. In stage 2, preliminary cultural modifications were made, the Hub was translated into Spanish, and a second focus group with the Latinx CRB was convened to review the revised Hub. In stage 3, semi-structured interviews with LSS parents of healthy boys (i.e., without hypospadias) ≤ 5 years old were conducted to identify any cultural adaptations and/or usability issues regarding the revised Hub. In stage 4, based on parents' feedback, final revisions to the Hub were made. The focus groups and parent interviews were conducted in Spanish; then, the recordings were professionally transcribed in Spanish and translated into English. Interviews with pediatricians were conducted in English; then, the recordings were professionally transcribed. Three coders conducted a qualitative content analysis to identify areas for revision. Changes were applied iteratively. RESULTS Participants included 3 Latinx CRB members (2 women, 1 did not disclose gender; mean age = 48.3, SD = 21.2), 3 non-Latinx pediatricians (2 women, 1 man; mean age = 49.6, SD = 9.1), and 5 Latinx mothers (mean age = 34.0, SD = 1.26). Participants recommended: 1) featuring video testimonials from Latinx families or including Spanish voice-overs/subtitles; 2) diversifying racial/ethnic/geographic representation and including extended families in photographs/illustrations; 3) adding information about health insurance coverage and circumcision, 4) reassuring parents that the condition is not their fault, 5) considering cultural values (e.g., reliance on expert advice), and 6) clarifying medical terminology. Feedback related to seven EVM dimensions: concepts, content, context, goals, language, metaphors, and methods. DISCUSSION Participants perceived the Hub to be informative in guiding parents' treatment decisions. Revisions were reasonable and acceptable for a linguistic and cultural adaptation for LSS parents. CONCLUSIONS We identified and implemented preliminary cultural modifications to the Hub and applied user-centered design methods to test and revise the website. The product is a culturally appropriate DA for LSS parents. Next, English and Spanish-versions of the Hub will be tested in a randomized controlled trial.
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Affiliation(s)
- Kelsey E Binion
- Department of Health Policy & Management, Indiana University Richard M. Fairbanks School of Public Health, Indianapolis, IN, USA.
| | - Krista M Perreira
- Department of Social Medicine, University of North Carolina School of Medicine, Chapel Hill, NC, USA.
| | - Laura Villa Torres
- Public Health Leadership Program, University of North Carolina Gillings School of Global Public Health, Chapel Hill, NC, USA.
| | - J Tommy White
- North Carolina Clinical and Translational Sciences Institute, University of North Carolina, Chapel Hill, NC, USA.
| | - Guadalupe C Hernandez
- North Carolina Clinical and Translational Sciences Institute, University of North Carolina, Chapel Hill, NC, USA.
| | - Martin Kaefer
- Department of Urology, Indiana University School of Medicine, Indianapolis, IN, USA.
| | - Rosalia Misseri
- Department of Urology, Indiana University School of Medicine, Indianapolis, IN, USA.
| | - Sherry Ross
- Department of Urology, University of North Carolina School of Medicine, Chapel Hill, NC, USA.
| | - Katherine H Chan
- Department of Urology, University of North Carolina School of Medicine, Chapel Hill, NC, USA; Department of Pediatrics, University of North Carolina School of Medicine, Chapel Hill, NC, USA.
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Buchanan CL, Morris MA, Matlock D, Kempe A, Vemulakonda VM. Parental experience and understanding of parent-provider discussions of treatment for infants with ureteropelvic junction obstruction. PEC INNOVATION 2023; 2:100142. [PMID: 37588298 PMCID: PMC10426279 DOI: 10.1016/j.pecinn.2023.100142] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 04/27/2022] [Revised: 02/16/2023] [Accepted: 02/18/2023] [Indexed: 08/18/2023]
Abstract
Objective The purpose of the current study was to understand what families identify as necessary information to guide decision-making in the treatment of their child with UPJO. Methods We conducted semi-structured interviews with parents of children with UPJO using phenomenological methodology. Data were systematically analyzed according to principles of thematic analysis, using a team-based inductive approach. Results 32 parents were interviewed. Findings are organized by three major themes including barriers to meaningful participation in decision making, logistical aspects of the decision, and psychosocial aspects of the decision. Conclusion These findings suggest the need to increase parent education and understanding around medical and surgical decision-making, and the need to enhance psychosocial support for more meaningful parental engagement in the surgical decision-making process. Practice implications The findings from the interviews highlight the importance of caregivers needing clear and accurate information in order to engage in meaningful discussions related to surgical decision-making for decisions around surgery for UPJO treatment.
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Affiliation(s)
- Cindy L. Buchanan
- Department of Psychiatry, University of Colorado School of Medicine, Aurora, USA
| | - Megan A. Morris
- Adult and Child Center for Outcomes Research and Delivery Science (ACCORDS), University of Colorado Anschutz Medical Campus, Aurora, USA
| | - Daniel Matlock
- Adult and Child Center for Outcomes Research and Delivery Science (ACCORDS), University of Colorado Anschutz Medical Campus, Aurora, USA
| | - Allison Kempe
- Adult and Child Center for Outcomes Research and Delivery Science (ACCORDS), University of Colorado Anschutz Medical Campus, Aurora, USA
| | - Vijaya M. Vemulakonda
- Department of Pediatric Urology, University of Colorado School of Medicine, Aurora, USA
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Ernst M, Klamer B, Thompson N, Alpert S, Dajusta D, Fuchs M, McLeod D, Jayanthi R, Ching C. Caregiver disclosure of common early childhood pediatric urologic surgeries. J Pediatr Urol 2023; 19:522.e1-522.e8. [PMID: 36898864 DOI: 10.1016/j.jpurol.2023.02.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/30/2022] [Revised: 02/16/2023] [Accepted: 02/19/2023] [Indexed: 02/25/2023]
Abstract
BACKGROUND Certain pediatric urologic diagnoses can have serious long-term adverse health outcomes. As a result, it is important for a child to be aware of their diagnosis and a prior surgery. When children have surgery prior to the age of memory formation, it is incumbent upon their caregiver to disclose this surgery. When and how to disclose this information and even if this occurs, is not clear. OBJECTIVE We developed a survey to assess caregiver plans to disclose early childhood pediatric urologic surgery and evaluate for predictors of disclosure and resources needed. METHODS A questionnaire was distributed to caregivers of male children ≤4 years old undergoing single stage repair of hypospadias, inguinal hernia, chordee, or cryptorchidism as part of an IRB approved research study. These surgeries were chosen due to being outpatient surgeries with potential long-term complications and impact. The age criteria was chosen due to likely being before patient memory formation and thus reliance on caregiver disclosure of prior surgery. Surveys were collected the day of surgery and contained information on caregiver demographics, validated health literacy screening, and plans to disclose surgery. RESULTS 120 survey responses were collected (Summary Table). The majority of caregivers responded affirmatively to planning to disclose their child's surgery (108; 90%). There was no impact of caregiver age, gender, race, marital status, education level, health literacy, or personal surgical history on plans to disclose surgery (p ≥ 0.05). Plan to disclose was also not different across urologic surgery type. Race was significantly associated with being "concerned or nervous about disclosing the surgery to the patient". The median patient age for planned disclosure was 10 years (IQR: 7-13). Only 17 respondents (14%) stated they received any information about how to discuss this surgery with the patient, however 83 (69%) felt this information would be helpful. CONCLUSIONS Our study suggests that most caregivers plan to discuss early childhood urologic surgeries with children, however want further guidance in how to talk to their child. While no specific surgery or demographic factor was found to be significantly associated with plans to disclose surgery, it is concerning that one in ten patients will potentially never learn about impactful surgery they had as a child. There is an opportunity for us to better counsel our patients' families about surgical disclosure and fill this gap with quality improvement efforts.
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Affiliation(s)
- Michael Ernst
- Nationwide Children's Hospital, Department of Urology, 700 Children's Drive, Columbus, OH, 43205, USA.
| | - Brett Klamer
- Nationwide Children's Hospital, Department of Urology, 700 Children's Drive, Columbus, OH, 43205, USA
| | - Nora Thompson
- Nationwide Children's Hospital, Department of Urology, 700 Children's Drive, Columbus, OH, 43205, USA
| | - Seth Alpert
- Nationwide Children's Hospital, Department of Urology, 700 Children's Drive, Columbus, OH, 43205, USA
| | - Daniel Dajusta
- Nationwide Children's Hospital, Department of Urology, 700 Children's Drive, Columbus, OH, 43205, USA
| | - Molly Fuchs
- Nationwide Children's Hospital, Department of Urology, 700 Children's Drive, Columbus, OH, 43205, USA
| | - Daryl McLeod
- Nationwide Children's Hospital, Department of Urology, 700 Children's Drive, Columbus, OH, 43205, USA
| | - Rama Jayanthi
- Nationwide Children's Hospital, Department of Urology, 700 Children's Drive, Columbus, OH, 43205, USA
| | - Christina Ching
- Nationwide Children's Hospital, Department of Urology, 700 Children's Drive, Columbus, OH, 43205, USA
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Tian AC, Graesser EA, Tarkunde Y, Frantz L, Wall LB. Caregiver Versus Surgeon Concerns in New Diagnosis of Congenital Hand and Upper Extremity Anomalies. J Hand Surg Am 2023; 48:896-903. [PMID: 37516940 DOI: 10.1016/j.jhsa.2023.05.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2023] [Revised: 04/23/2023] [Accepted: 05/22/2023] [Indexed: 07/31/2023]
Abstract
PURPOSE The initial office visit can be a stressful time for families with children with congenital upper extremity differences. These families may have concerns that differ from the information that pediatric hand surgeons believe is important to discuss. The purpose of this study was to compare topics that families and surgeons believe are most important to address at the initial office visits to better inform and guide that visit. METHODS Qualitative interviews were conducted with 15 pediatric hand surgeons and 17 caregivers of children with congenital upper extremity differences. Interviews were conducted using semi-structured guides. Interviews were recorded, transcribed, and analyzed using thematic analysis to identify recurring themes from both study groups. RESULTS Overarching themes were similar between the groups and included diagnosis/cause, treatment, psychosocial considerations, future outcomes, and further resources. However, emphasis among these themes differed, with surgeons emphasizing the cause and events leading up to the diagnosis and caregivers preferring to discuss next steps and treatment options. Surgeons also discussed feelings of grief or guilt more commonly than the caregivers. CONCLUSIONS Although surgeons emphasize the cause and psychosocial impact of a newly diagnosed congenital upper extremity difference at the initial office visit, caregivers mostly focused on the future and next steps that can be taken. CLINICAL RELEVANCE Surgeons should ensure to address these issues so that families are comfortable with the treating surgeon and believe that their concerns are being adequately addressed.
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Affiliation(s)
- Andrea C Tian
- Department of Orthopaedic Surgery, Washington University School of Medicine, Saint Louis, MO.
| | - Elizabeth A Graesser
- Department of Orthopaedic Surgery, Washington University School of Medicine, Saint Louis, MO
| | - Yash Tarkunde
- Department of Orthopaedic Surgery, Washington University School of Medicine, Saint Louis, MO
| | - Lisa Frantz
- Department of Orthopedic Surgery and Sports Medicine, University of Kansas Medical Center, Kansas City, KS
| | - Lindley B Wall
- Department of Orthopaedic Surgery, Washington University School of Medicine, Saint Louis, MO
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Binion KE, Rode AU, Nortey G, Miller AD, Misseri R, Kaefer M, Ross S, Preisser JS, Hu D, Chan KH. A multi-site pilot study of a parent-centered tool to promote shared decision-making in hypospadias care. J Pediatr Urol 2023; 19:290.e1-290.e10. [PMID: 36801199 PMCID: PMC10278576 DOI: 10.1016/j.jpurol.2023.01.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2022] [Revised: 12/14/2022] [Accepted: 01/30/2023] [Indexed: 02/10/2023]
Abstract
BACKGROUND Using a user-centered design approach, we conducted a two-site pilot study to evaluate a decision aid (DA) website, the Hypospadias Hub, for parents of hypospadias patients. OBJECTIVES The objectives were to assess the Hub's acceptability, remote usability, and feasibility of study procedures, and to evaluate its preliminary efficacy. METHODS From June 2021-February 2022, we recruited English-speaking parents (≥18 years old) of hypospadias patients (≤5 years) and delivered the Hub electronically ≤2 months before their hypospadias consultation. We collected website analytic data using an ad tracker plug-in. We inquired about treatment preference, hypospadias knowledge, and decisional conflict (Decisional Conflict Scale) at baseline, after viewing the Hub (pre-consultation), and post-consultation. We administered the Decision Aid Acceptability Questionnaire (DAAQ) and the Preparation for Decision-Making Scale (PrepDM) which assessed how well the Hub prepared parents for decision-making with the urologist. Post-consultation, we assessed participants' perception of involvement in decision-making with the Shared Decision-making Questionnaire (SDM-Q-9) and the Decision Regret Scale (DRS). A bivariate analysis compared participants' baseline and pre/post-consultation hypospadias knowledge, decisional conflict, and treatment preference. Using a thematic analysis, we analyzed our semi-structured interviews to uncover how the Hub impacted the consultation and what influenced participants' decisions. RESULTS Of 148 parents contacted, 134 were eligible and 65/134 (48.5%) enrolled: mean age 29.2, 96.9% female, 76.6% White (Extended Summary Figure). Pre/post-viewing the Hub, there was a statistically significant increase in hypospadias knowledge (54.3 vs. 75.6, p < 0.001) and decrease in decisional conflict (36.0 vs. 21.9, p < 0.001). Most participants (83.3%) thought Hub's length and amount of information (70.4%) was "about right", and 93.0% found most or everything was clear. Pre/post-consultation, there was a statistically significant decrease in decisional conflict (21.9 vs. 8.8, p < 0.001). PrepDM's mean score was 82.6/100 (SD = 14.1); SDM-Q-9's mean score was 82.5/100 (SD = 16.7). DCS's mean score was 25.0/100 (SD = 47.03). Each participant spent an average of 25.75 min reviewing the Hub. Based on thematic analysis, the Hub helped participants feel prepared for the consultation. DISCUSSION Participants engaged extensively with the Hub and demonstrated improved hypospadias knowledge and decision quality. They felt prepared for the consultation and perceived a high degree of involvement in decision-making. CONCLUSION As the first pilot test of a pediatric urology DA, the Hub was acceptable and study procedures were feasible. We plan to conduct a randomized controlled trial of the Hub versus usual care to test its efficacy to improve the quality of shared decision-making and reduce long-term decisional regret.
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Affiliation(s)
- Kelsey E Binion
- Department of Communication Studies, Indiana University Purdue University, Indianapolis, IN, USA.
| | - Akash Uday Rode
- Department of Human-Centered Computing, Luddy School of Informatics, Computing, and Engineering, Indiana University, Indianapolis, IN, USA.
| | - Gabrielle Nortey
- Department of Urology, University of North Carolina School of Medicine, Chapel Hill, NC, USA.
| | - Andrew D Miller
- Department of Human-Centered Computing, Luddy School of Informatics, Computing, and Engineering, Indiana University, Indianapolis, IN, USA.
| | - Rosalia Misseri
- Department of Urology, Indiana University School of Medicine, Indianapolis, IN, USA.
| | - Martin Kaefer
- Department of Urology, Indiana University School of Medicine, Indianapolis, IN, USA.
| | - Sherry Ross
- Department of Urology, University of North Carolina School of Medicine, Chapel Hill, NC, USA.
| | - John S Preisser
- Department of Biostatistics, University of North Carolina Gillings School of Global Public Health, Chapel Hill, NC, USA.
| | - Di Hu
- Department of Biostatistics, University of North Carolina Gillings School of Global Public Health, Chapel Hill, NC, USA.
| | - Katherine H Chan
- Department of Urology, University of North Carolina School of Medicine, Chapel Hill, NC, USA; Department of Pediatrics, University of North Carolina School of Medicine, Chapel Hill, NC, USA.
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Maillard J, Beckmann TS, Tramèr MR, Elia N. Reviewing next of kin regrets in surgical decision-making: cross-sectional analysis of systematically searched literature. J Patient Rep Outcomes 2023; 7:5. [PMID: 36695927 PMCID: PMC9877257 DOI: 10.1186/s41687-023-00539-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2022] [Accepted: 01/03/2023] [Indexed: 01/26/2023] Open
Abstract
BACKGROUND Decision-making concerning relatives undergoing surgery is challenging. It remains unclear to what extent implicated next of kin eventually regret their decisions and how this regret is assessed. Our aim was to systematically review the literature on decisional regret of next of kin and to describe the assessment tools used and the surgical populations studied. METHODS We included interventional or observational, quantitative or qualitative studies reporting the measurement of decisional regret of next of kin concerning relatives undergoing surgery. We searched a variety of databases without restriction on publication year. We assessed the quality of reporting of quantitative studies using the NIH Quality Assessment Tool for Observational Cohort and Cross-Sectional Studies and of qualitative studies using the Critical Appraisal Skills Program Checklist. RESULTS Thirteen cross-sectional, five prospective cohorts and five qualitative studies matched our inclusion criteria. In 18 studies (78%), patients were children, in five (22%), young or middle-aged adults. No study included elderly or frail patients. Thirteen studies (57%) used the original Decision Regret Scale which was validated for patients, but not for next of kin. Only 3 of the 18 (17%) quantitative studies and only one of the 4 (25%) qualitative studies were rated as "good" in the quality assessment. CONCLUSION None of the retrieved studies used validated tools to assess the decisional regret of next of kin and none of them examined this issue in elderly or frail surgical patients.
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Affiliation(s)
- Julien Maillard
- grid.150338.c0000 0001 0721 9812Division of Anesthesiology, Department of Anesthesiology, Pharmacology, Intensive Care and Emergency Medicine, Geneva University Hospitals, Rue Gabrielle-Perret-Gentil 4, 1205 Geneva, Switzerland
| | - Tal S. Beckmann
- grid.150338.c0000 0001 0721 9812Division of Anesthesiology, Department of Anesthesiology, Pharmacology, Intensive Care and Emergency Medicine, Geneva University Hospitals, Rue Gabrielle-Perret-Gentil 4, 1205 Geneva, Switzerland
| | - Martin R. Tramèr
- grid.150338.c0000 0001 0721 9812Division of Anesthesiology, Department of Anesthesiology, Pharmacology, Intensive Care and Emergency Medicine, Geneva University Hospitals, Rue Gabrielle-Perret-Gentil 4, 1205 Geneva, Switzerland
| | - Nadia Elia
- grid.150338.c0000 0001 0721 9812Division of Anesthesiology, Department of Anesthesiology, Pharmacology, Intensive Care and Emergency Medicine, Geneva University Hospitals, Rue Gabrielle-Perret-Gentil 4, 1205 Geneva, Switzerland
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Phillips L, Dennermalm N, Örtqvist L, Engberg H, Holmdahl G, Fossum M, Möller A, Nordenskjöld A. A qualitative content analysis of the experience of hypospadias care: The importance of owning your own narrative. Front Pediatr 2023; 11:1118586. [PMID: 36873641 PMCID: PMC9982152 DOI: 10.3389/fped.2023.1118586] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2022] [Accepted: 01/31/2023] [Indexed: 02/19/2023] Open
Abstract
OBJECTIVES There is a lack of studies on men's individual experiences of living with hypospadias. We aimed to explore the personal experiences of having hypospadias in relation to healthcare and surgery. SUBJECTS AND METHODS Purposive sampling was used to include men (aged 18 and over) with hypospadias representing different phenotypes (from distal to proximal) and ages in order to maximise the variation and richness of our data. Seventeen informants, aged 20-49, were included in the study. In-depth semi-structured interviews were conducted between 2019 and 2021. Inductive qualitative content analysis was used to analyse the data. RESULTS We identified three categories: (1) Having surgery, which comprised the decision to operate, the experience of having surgery, and the outcomes of surgery; (2) Going to the doctor, which focused on follow-up care, re-entering care in adolescence or adulthood, and the experience of healthcare interactions; (3) Being informed, both about hypospadias in general, as well as about your specific body and medical history. There was overall a large variation in experiences. The latent theme across the data was the importance of owning your own narrative. CONCLUSION The experience of men with hypospadias in healthcare is complex and varied, highlighting the difficulty of fully standardised care. Based on our results, we suggest that follow-up should be offered in adolescence, and that ways of accessing care for late onset complications be made clear. We further suggest clearer consideration for the psychological and sexual aspects of hypospadias. Consent and integrity in all aspects and all ages of hypospadias care should be adapted to the maturity of the individual. Access to trustworthy information is key, both directly from educated healthcare staff and if possible, from websites or patient-led forums. Healthcare can play a key role in providing the growing individual with tools to understand and address concerns that may develop relating to their hypospadias through life, giving them ownership over their own narrative.
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Affiliation(s)
- Lottie Phillips
- Department of Women's and Children's Health and Center of Molecular Medicine, Karolinska Institutet, Stockholm, Sweden
| | | | - Lisa Örtqvist
- Department of Women's and Children's Health and Center of Molecular Medicine, Karolinska Institutet, Stockholm, Sweden.,Department of Paediatric Surgery, Astrid Lindgren Children's Hospital, Karolinska University Hospital, Stockholm, Sweden
| | - Hedvig Engberg
- Department of Women's and Children's Health and Center of Molecular Medicine, Karolinska Institutet, Stockholm, Sweden.,Department of Gynecology and Reproductive Medicine, Karolinska University Hospital, Stockholm, Sweden
| | - Gundela Holmdahl
- Department of Women's and Children's Health and Center of Molecular Medicine, Karolinska Institutet, Stockholm, Sweden.,Department of Paediatric Surgery, Astrid Lindgren Children's Hospital, Karolinska University Hospital, Stockholm, Sweden
| | - Magdalena Fossum
- Department of Women's and Children's Health and Center of Molecular Medicine, Karolinska Institutet, Stockholm, Sweden.,Department of Paediatric Surgery and Faculty of Health and Medical Sciences, Rigshospitalet, University Hospital of Copenhagen, Copenhagen, Denmark
| | - Anders Möller
- School of Public Health and Community Medicine, Institute of Medicine, University of Gothenburg, Gothenburg, Sweden
| | - Agneta Nordenskjöld
- Department of Women's and Children's Health and Center of Molecular Medicine, Karolinska Institutet, Stockholm, Sweden.,Department of Paediatric Surgery, Astrid Lindgren Children's Hospital, Karolinska University Hospital, Stockholm, Sweden
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Significance of Continuous Nursing of Omaha System in Children after Hypospadias Surgery and Its Influence on Infection Complications. CONTRAST MEDIA & MOLECULAR IMAGING 2022; 2022:8346848. [PMID: 36105447 PMCID: PMC9458415 DOI: 10.1155/2022/8346848] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/23/2022] [Revised: 08/03/2022] [Accepted: 08/09/2022] [Indexed: 12/02/2022]
Abstract
Objective The aim of the research article is to explore the significance of continuous nursing of the Omaha system in children after hypospadias surgery and its influence on infection complications. Methods From April 2019 to April 2021, Anhui Provincial Children's Hospital treated 76 children with hypospadias and they were selected as the research objects. In the light of the random number table method, children were classified into the control group and the study group, with 38 cases in each group. The control group applied routine postoperative nursing intervention, while the study group received Omaha system continuous nursing intervention based on the control group. The Omaha system outcome evaluation, complication rate, quality of life, and nursing satisfaction were recorded and discussed in all children. Results The levels of physiological and psychological environment and health behavior in both groups after intervention were significantly higher than those before the intervention, and the levels of all dimensions in the study group were significantly higher than those in the control group (P < 0.05); the complication rate in the study group was 10.53% significantly lower than that in the control group (28.95%). After intervention, the physiological function, psychological and social function, emotional function, social interaction, and school status of the two groups were significantly higher than before intervention, and the score of each dimension in the study group was significantly higher than that in the control group (P < 0.05); the overall satisfaction of nursing in the study group was 94.74% significantly better than in the control group (81.59%) (P < 0.05). Conclusion The continuous nursing intervention of the Omaha system for children with hypospadias can significantly improve the clinical condition of children, reduce the risk of infection complications, improve children's physical and mental health status, and improve nursing satisfaction, which is worthy of clinical practice.
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Vavilov S, Roberts E, Smith GHH, Starkey M, Pockney P, Deshpande AV. Parental decision regret among Australian parents after consenting to or refusing hypospadias repair for their son: Results of a survey with controls. J Pediatr Urol 2022; 18:482-488. [PMID: 35659825 DOI: 10.1016/j.jpurol.2022.04.023] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2022] [Revised: 04/03/2022] [Accepted: 04/30/2022] [Indexed: 11/15/2022]
Abstract
INTRODUCTION Parental decision regret in hypospadias surgery is a recognised source of long-lasting psycho-social morbidity. High parental decision regret after their child's hypospadias repair is reported. The aim of this study is to report on decision regret in Australian parents, who accepted and declined surgery for their son and explore underlying factors for decision-making, satisfaction, and regret. MATERIALS AND METHODS An online anonymous survey was administered to three groups of parents: 1) parents who consented for hypospadias repair, 2) parents who declined repair and 3) a control group who requested circumcision for their child. Operations occurred between 2010 and 2020 in two paediatric hospitals in New South Wales, Australia. The survey included a validated decision regret assessment tool and additional questions to explore the possible basis of the opinions. RESULTS One hundred and eighteen parents (invited - 381, completed - 116, response rate - 31%) participated in the survey. Decision regret was present in group 1 (n = 89) - 55% (moderate-to-severe 15%), in group 2 (n = 14) - 71% (moderate-to-severe 57%), and in the control group (n = 15) - 15% (moderate-to-severe 8%) of parents. There was a significant difference in the median decision regret score between all three groups. Parents who chose hypospadias repair were mostly concerned about function. CONCLUSIONS The prevalence of decision regret among Australian parents who consented for their son's hypospadias repair was lower compared with the mean decision regret reported in the literature to date (55% vs 65%). Decision regret and its severity were highest among parents who declined hypospadias repair. New strategies are needed to reduce decision regret in parents whether they elect for surgery or not.
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Affiliation(s)
- Sergey Vavilov
- School of Medicine and Public Health, The University of Newcastle, NSW, Australia; Urology Unit, Department of Surgery, The Children's Hospital at Westmead, NSW, Australia.
| | - Elysa Roberts
- Department of Occupational Therapy, School of Health Sciences, The University of Newcastle, NSW, Australia.
| | - Grahame H H Smith
- Urology Unit, Department of Surgery, The Children's Hospital at Westmead, NSW, Australia; Department of Paediatrics and Child Health, The University of Sydney, NSW, Australia.
| | - Malcolm Starkey
- Department of Immunology and Pathology, Central Clinical School, Monash University and Alfred Research Alliance, Melbourne, VIC, Australia; School of Biomedical Sciences and Pharmacy, College of Health and Well Being, The University of Newcastle, NSW, Australia.
| | - Peter Pockney
- School of Medicine and Public Health, The University of Newcastle, NSW, Australia; Discipline of Surgery, Medical School, The University of Western Australia, Perth, Australia.
| | - Aniruddh V Deshpande
- School of Medicine and Public Health, The University of Newcastle, NSW, Australia; Urology Unit, Department of Surgery, The Children's Hospital at Westmead, NSW, Australia; Faculty of Medicine, The University of Sydney, NSW, Australia.
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11
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Blankstein U, McGrath M, Randhawa H, Braga LH. A survey of parental perceptions and attitudes related to disclosure in hypospadias repair. J Pediatr Urol 2022; 18:178.e1-178.e7. [PMID: 35181223 DOI: 10.1016/j.jpurol.2022.01.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2021] [Revised: 01/13/2022] [Accepted: 01/14/2022] [Indexed: 11/29/2022]
Abstract
INTRODUCTION Boys with hypospadias often undergo reconstructive surgery to improve cosmetic appearance and functional outcomes. While the ethics of physician-patient disclosure of illness are clear, parent-child disclosure is more ambiguous. There is a paucity of research regarding the parental disclosure of past urological procedures, specifically hypospadias repair. Our objective was to determine the rate of parental disclosure in boys undergoing hypospadias repair, and to evaluate the parental perspectives regarding concerns and amount of support in relation. METHODS A web-based questionnaire was distributed to parents of 240 hypospadias patients at our pediatric urology outpatient clinic over 12 months. The questionnaire assessed intent to disclose, decisional regret, and cosmetic perception. Data was analyzed using descriptive statistics and chi-square analyses. RESULTS Two hundred and twenty-three survey responses were collected. The majority of respondents were urban dwellers (72.2%), and the mothers of the child (80.9%). Distal hypospadias was the most common variant of condition (62.7%). When asked if they plan to disclose the repair to their child, 93% said "yes", and of those, the optimal mean age of disclosure was 7.49 ± 4.30 years. Ninety percent reported that they were not offered guidance on how/when to disclose, and 43% thought they would benefit from support on this. There was a significant difference in nervousness to disclose if the condition was distal versus proximal (χ2 = 15.19, p=<0.01), with proximal being more nervous. A significant difference was also observed regarding disclosure support with proximal being more likely to want formal support (χ2 = 4.55, p = 0.03). DISCUSSION AND CONCLUSIONS As hypothesized, the majority of parents intended to disclose their son's surgery to them, but no statistically significant difference was seen between those with a distal vs. proximal repair. Additionally, demographic characteristics which were hypothesized to influence this decision (e.g., parents' level of education and relationship to the child) did not discriminate parental intent to disclose. To our knowledge, this is the first study to evaluate perceptions and attitudes around disclosure in patients with hypospadias and their families. The majority of respondents were planning to disclose the operation to their child, and were not offered any guidance or support as to the optimal way to disclose. Half of those parents thought they could benefit from resources to help them with this process. Further research is required to understand the impact of disclosure and to create tools to help caregivers with this responsibility.
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Affiliation(s)
- Udi Blankstein
- Division of Urology, McMaster University, Hamilton, Ontario, Canada
| | - Melissa McGrath
- Division of Urology, McMaster University, Hamilton, Ontario, Canada; McMaster Pediatric Surgery Research Collaborative, Department of Surgery, McMaster University, Hamilton, Ontario, Canada
| | | | - Luis H Braga
- Division of Urology, McMaster University, Hamilton, Ontario, Canada; McMaster Pediatric Surgery Research Collaborative, Department of Surgery, McMaster University, Hamilton, Ontario, Canada; Deparment of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Ontario, Canada.
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12
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Binion K, Miller A, Misseri R, Kaefer M, Longtin K, Carroll A, Wiehe SE, Chan KH. Ask the parents: Testing the acceptability and usability of a hypospadias decision aid. J Pediatr Urol 2022; 18:170.e1-170.e9. [PMID: 35131196 PMCID: PMC9167211 DOI: 10.1016/j.jpurol.2022.01.004] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2021] [Revised: 12/16/2021] [Accepted: 01/10/2022] [Indexed: 12/23/2022]
Abstract
INTRODUCTION In previous work, we engaged key stakeholders to create a web-based decision aid (DA) prototype to facilitate shared decision making about hypospadias. OBJECTIVE The study's objective was to use a human-centered design approach to assess the DA's acceptability and usability and revise it prior to pilot testing. METHODS We recruited English-speaking parents (≥18 years old) of sons with hypospadias (≤5 years) for a two-phase process of semi-structured phone/video interviews to obtain feedback about our DA prototype. DA webpages included: "Hypospadias," "Surgery Basics," "No Surgery," "Family Stories," "Help Me Decide," and "FAQs." In both phases, participants viewed the DA using the "think aloud" technique and completed several validated scales to evaluate its acceptability and usability. In phase 1, we collected feedback about the "Homepage" organization, values clarification methods (VCM), and webpage content. In phase 2, participants searched the DA for answers to hypospadias-related questions, provided feedback on testimonial videos and VCM, and shared their preferences about data visualizations. All interviews were audio recorded. After each phase, transcripts were qualitatively analyzed to identify key areas for revision. Revisions were made between phase 1 and 2 to improve the DA's acceptability and usability. RESULTS We interviewed 20 participants (10/phase): median age 33.7 years, 60% female, 80% White. Mean score on the Preparation for Decision Making Scale: 86.8 (out of 100). We revised: 1) VCM, focusing on pros/cons of surgery and question prompts, 2) "Homepage," adding webpage descriptions (Extended Summary Figure), 3) menu organization, 4) "Surgery Day" webpage, adding general anesthesia risk information, and 5) "Hypospadias" webpage, adding an icon bar graph to help participants visualize statistics. Participants thought the testimonial videos were relatable and the VCMs would prepare them for their visit with their child's urologist. DISCUSSION Ours is the first parent-centered DA developed and pre-tested for hypospadias. Using validated usability and acceptability scales, participants highly rated the DA in helping them arrive at a decision about surgery. Study limitations include the sample's lack of diversity (i.e., educated, health literate) and participants already decided about their son's hypospadias management before enrolling. To learn more about the DA's usability and acceptability, we plan to pilot test it in a clinical setting. CONCLUSIONS Participants found our DA informative in understanding hypospadias. There was a high perceived level of preparation for hypospadias decision making. Participatory research methods, such as "think aloud," may be helpful when testing DAs as they privilege the patient's experience.
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Affiliation(s)
- Kelsey Binion
- Department of Communication Studies, Indiana University Purdue University, Indianapolis, IN, USA.
| | - Andrew Miller
- Department of Human-Centered Computing, Indiana University Purdue University, Indianapolis, IN, USA.
| | - Rosalia Misseri
- Department of Urology, Indiana University School of Medicine, Indianapolis, IN, USA.
| | - Martin Kaefer
- Department of Urology, Indiana University School of Medicine, Indianapolis, IN, USA.
| | - Krista Longtin
- Department of Communication Studies, Indiana University Purdue University, Indianapolis, IN, USA.
| | - Aaron Carroll
- Center for Pediatric and Adolescent Comparative Effectiveness Research, Indiana University School of Medicine, Indianapolis, IN, USA.
| | - Sarah E Wiehe
- Children's Health Services Research, Indiana University School of Medicine, Indianapolis, Indiana; Research Jam, Indiana Clinical and Translational Sciences Institute, Indianapolis, IN, USA.
| | - Katherine H Chan
- Department of Pediatrics, Indiana University School of Medicine, Indianapolis, IN, USA; Department of Urology, University of North Carolina, Chapel Hill, NC, USA.
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Sandberg DE, Gardner M. Differences/Disorders of Sex Development: Medical Conditions at the Intersection of Sex and Gender. Annu Rev Clin Psychol 2022; 18:201-231. [PMID: 35216524 PMCID: PMC10170864 DOI: 10.1146/annurev-clinpsy-081219-101412] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Defined as congenital conditions in which development of chromosomal, gonadal, or anatomic sex is atypical, differences or disorders of sex development (DSDs) comprise many discrete diagnoses ranging from those associated with few phenotypic differences between affected and unaffected individuals to those where questions arise regarding gender of rearing, gonadal tumor risk, genital surgery, and fertility. Controversies exist in numerous areas including how DSDs are conceptualized, how to refer to the set of conditions and those affected by them, and aspects of clinical management that extend from social media to legislative bodies, courts of law, medicine, clinical practice, and scholarly research in psychology and sociology. In addition to these aspects, this review covers biological and social influences on psychosocial development and adjustment, the psychosocial and psychosexual adaptation of people born with DSDs, and roles for clinical psychologists in the clinical management of DSDs. Expected final online publication date for the Annual Review of Clinical Psychology, Volume 18 is May 2022. Please see http://www.annualreviews.org/page/journal/pubdates for revised estimates.
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Affiliation(s)
- David E Sandberg
- Susan B. Meister Child Health Evaluation and Research Center, University of Michigan Medical School, Ann Arbor, Michigan, USA;
| | - Melissa Gardner
- Susan B. Meister Child Health Evaluation and Research Center, University of Michigan Medical School, Ann Arbor, Michigan, USA;
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Wishahi M, Elkholy A, Badawy MH. Repair of distal hypospadias by construction of neourethra from augmented urethral plate with two lateral strips of glans skin and coverage with dartos flap followed by skin closure with preputial flap: single center series. Cent European J Urol 2021; 73:526-533. [PMID: 33552580 PMCID: PMC7848827 DOI: 10.5173/ceju.2020.0065.r4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2019] [Revised: 06/08/2020] [Accepted: 07/16/2020] [Indexed: 11/22/2022] Open
Abstract
Introduction Hypospadias is one of the most common anomalies in boys. Many surgical techniques for reconstruction of distal hypospadias have been described, each method having a different success rate. Our objective in this study is the assessment of the surgical technique for repair of distal hypospadias by construction of a neourethra from the augmented urethral plate with two lateral strips of glanular skin, coverage with a dartos flap, and followed by skin closure with preputial skin flap. Material and methods From March 2016 to November 2018, repair of distal hypospadias was performed in 56 children with a mean age of 3.2 years (range 2 to 8 years old). Minimum follow-up was 12 months, maximum up to 24 months. Success was defined by cosmetic appearance of the penis, parent perception of penile appearance, and urinary function. Uroflowmetry was done in 22 children at the 12 months follow-up. Parents evaluation of procedure was done by questionnaire using the pediatric penile perception score (PPPS). Results The results were successful with straight penile shaft, conical glans, slit-like meatus located at the tip of the glans, with no rotation, and normal micturition. Five children had urethrocutaneous fistula (8.9%) that were treated with simple closure. Parents reported 'very satisfactory' (98.2%) and 'satisfactory' (1.8%). Conclusions The described technique of repair of distal hypospadias in children with different variants of urethral plate width and glans size showed good results, both operator's and parent's perception of the results being very satisfactory. This technique is categorised stage 2a in the IDEAL (Idea, Development, Evaluation, Assessment, and Long-term study) staging system for surgical innovations.
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Affiliation(s)
- Mohamed Wishahi
- Theodor Bilharz Research Institute, Department of Urology, Cairo, Egypt
| | - Amr Elkholy
- Theodor Bilharz Research Institute, Department of Urology, Cairo, Egypt
| | - Mohamed H Badawy
- Theodor Bilharz Research Institute, Department of Urology, Cairo, Egypt
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Vavilov S, Smith G, Starkey M, Pockney P, Deshpande AV. Parental decision regret in childhood hypospadias surgery: A systematic review. J Paediatr Child Health 2020; 56:1514-1520. [PMID: 32885548 DOI: 10.1111/jpc.15075] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2020] [Revised: 06/12/2020] [Accepted: 06/16/2020] [Indexed: 11/29/2022]
Abstract
We conducted a systematic review of the literature to establish the prevalence of and predictive factors for parental decision regret in hypospadias surgery. A search strategy without language restrictions was developed with expert help, and two reviewers undertook independent study selection. Five studies were included in this review (four for quantitative analysis) with a total of 783 participants. The mean overall prevalence of parental decision regret was 65.2% (moderate to severe - 20.3%). Although significant predictors of regret were identified (post-operative complications, small size glans, meatal location, decision conflict between parents, parental educational level and others), they had unexplained discordance between studies. Parental decision regret after proximal hypospadias surgery and refusing surgery was inadequately reported. In conclusion, even though the prevalence of parental decision regret after consenting for the hypospadias repair appears to be high, risk factors associated with it were discordant suggesting imprecision in estimates due to unknown confounders.
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Affiliation(s)
- Sergey Vavilov
- Faculty of Health and Medicine, University of Newcastle, Newcastle, New South Wales, Australia.,Department of Surgery, John Hunter Hospital, Newcastle, New South Wales, Australia
| | - Grahame Smith
- Urology Unit, Department of Surgery, The Children's Hospital at Westmead, Sydney, New South Wales, Australia
| | - Malcolm Starkey
- Department of Immunology and Pathology, Central Clinical School, Monash University, Melbourne, Victoria, Australia.,Priority Research Centre GrowUpWell, Faculty of Health and Medicine, The University of Newcastle, Newcastle, New South Wales, Australia
| | - Peter Pockney
- Faculty of Health and Medicine, University of Newcastle, Newcastle, New South Wales, Australia.,Department of Surgery, John Hunter Hospital, Newcastle, New South Wales, Australia
| | - Aniruddh V Deshpande
- Urology Unit, Department of Surgery, The Children's Hospital at Westmead, Sydney, New South Wales, Australia.,Priority Research Centre GrowUpWell, Faculty of Health and Medicine, The University of Newcastle, Newcastle, New South Wales, Australia.,Centre for Kidney Research, The Children's Hospital at Westmead, Sydney, New South Wales, Australia
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16
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Chan KH, Misseri R, Carroll A, Frankel RM, Moore C, Cockrum B, Wiehe S. User testing of a hypospadias decision aid prototype at a pediatric medical conference. J Pediatr Urol 2020; 16:685.e1-685.e8. [PMID: 32919901 PMCID: PMC8788200 DOI: 10.1016/j.jpurol.2020.08.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2020] [Accepted: 08/08/2020] [Indexed: 10/23/2022]
Abstract
INTRODUCTION Based on our previous qualitative work, we created a web-based decision aid (DA) prototype to facilitate shared decision-making regarding hypospadias. OBJECTIVE The objective of this study was to obtain rapid feedback on the prototype as part of an iterative, human-centered design process. METHODS We conducted this study at a statewide, pediatric educational conference in May 2019, recruiting attendees by verbal/written announcements. The DA consisted of: hypospadias overview and surgery "storyboard," frequently asked questions, parent testimonials, and a values clarification exercise. Participants viewed the DA on a tablet as they participated in semi-structured, qualitative interviews covering website acceptability, usability, and preference for surgical photographs versus illustrations. Three coders used qualitative content analysis to identify themes and resolved disagreements by consensus. RESULTS Of 295 conference attendees, all 50 who approached us agreed to participate. Responses from 49 participants were available for analysis: 67% female, ages 20-69, 65% Caucasian, 55% MDs. 96% of participants thought the website design matched its purpose; 59.1% preferred surgical illustrations, 8.2% preferred photos, 30.6% preferred both and 2.0% did not like either. Participants recommended improvements in: a) usability/accessibility (e.g. site navigation, visual layout, page length), b) content coverage (e.g. epidemiology, consequences of no/delayed surgery, lifelong risks), c) parent-centeredness (e.g. reading level/writing style) and d) implementation (provider tools, printable handouts). The Extended Summary Figure shows a revised image of the first step of a hypospadias repair based on feedback about participants' preferences for illustrations rather than photographs. DISCUSSION The main strength of our study was the valuable feedback we obtained to inform critical revisions of the DA prototype. We also demonstrated the feasibility and efficacy of a conducting a usability evaluation of a web-based DA in a medical conference setting. One limitation of this study is that the relatively small population sampled limits generalizability and our findings may not reflect the views of all providers who care for hypospadias patients. CONCLUSIONS The vast majority of providers thought that the design of the Hypospadias Homepage matched its purpose and most preferred surgical illustrations rather than photos to demonstrate the steps of hypospadias surgery. Based on their feedback, we plan to focus our efforts in the following areas: 1) improvement of navigation/menus, 2) reduction in the amount of text per page, 3) expansion of specific content coverage and 4) inclusion of "parent-friendly" visuals such as infographics to represent quantitative data and colorful illustrations to depict hypospadias and its surgical repair.
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Affiliation(s)
- Katherine H Chan
- Department of Urology, Indiana University School of Medicine, Indianapolis, IN, USA; Department of Pediatrics: Center for Pediatric and Adolescent Comparative Effectiveness Research Indianapolis, IN, USA.
| | - Rosalia Misseri
- Department of Urology, Indiana University School of Medicine, Indianapolis, IN, USA.
| | - Aaron Carroll
- Department of Pediatrics: Center for Pediatric and Adolescent Comparative Effectiveness Research Indianapolis, IN, USA.
| | - Richard M Frankel
- Department of Medicine, Indiana University School of Medicine, Indiana and Cleveland Clinic Learner Institute, Indianapolis, Cleveland, OH, USA.
| | - Courtney Moore
- Research Jam (Patient Engagement Core), Indiana Clinical and Translational Sciences Institute, Indiana University School of Medicine Indianapolis, IN, USA.
| | - Brandon Cockrum
- Research Jam (Patient Engagement Core), Indiana Clinical and Translational Sciences Institute, Indiana University School of Medicine Indianapolis, IN, USA.
| | - Sarah Wiehe
- Children's Health Services Research Center, Indiana University School of Medicine, Indianapolis, IN, USA; Research Jam (Patient Engagement Core), Indiana Clinical and Translational Sciences Institute, Indiana University School of Medicine Indianapolis, IN, USA.
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Chan KH, Misseri R, Carroll A, Frankel R, Moore CM, Cockrum B, Wiehe SE. User-centered development of a hypospadias decision aid prototype. J Pediatr Urol 2020; 16:684.e1-684.e9. [PMID: 32863127 PMCID: PMC7686073 DOI: 10.1016/j.jpurol.2020.07.047] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2020] [Revised: 07/23/2020] [Accepted: 07/31/2020] [Indexed: 10/23/2022]
Abstract
INTRODUCTION Many parents who choose hypospadias repair for their sons experience decisional conflict (DC) and decisional regret (DR). We previously found that parental decision-making about hypospadias surgery is a complex process characterized by cyclic information-seeking to alleviate anxiety and confusion. OBJECTIVE The objective of this study was to engage parents of hypospadias patients and pediatric providers in the co-design of a decision aid (DA) prototype to facilitate shared decision-making about hypospadias surgery and address DC and DR. METHODS From August 2018 to January 2019, we conducted three co-design workshops with parents of hypospadias patients, pediatric urology and general pediatric providers to discuss their recommendations for a DA prototype. Activities were audio recorded and professionally transcribed. Transcripts and worksheets were analyzed by six coders using qualitative analysis to identify key aspects of a hypospadias DA desired by stakeholders. We conducted a collaborative design and prototyping session to establish key features and requirements, created a content map visualizing this work, and then developed a DA prototype. RESULTS Parent participants included 6 mothers and 4 fathers: 8 Caucasian, 2 African-American; median age 31 years. Providers included pediatric urology (n = 7) and general pediatric providers (n = 10): median age 47.5 years, 83.3% Caucasian, 58.3% male, 58.3% MD's and 41.7% nurse practitioners. Participants created user-friendly, interactive DA prototypes with "24/7" availability that had three key functions: 1) provide accurate, customizable, educational content, 2) connect parents with each other, and 3) engage them in a decision-making activity. The prototype consisted of five modules (Extended Summary Figure). "Hypospadias Basics" includes epidemiology and a hypospadias severity scale. "Surgery Basics" includes goals, illustrated steps, and pros/cons of surgery. "Testimonials" includes videos of parents and adolescents discussing their experiences. "Help me Decide" includes a decisional conflict scale and a decision-making activity (i.e. values clarification method). "Frequently Asked Questions" covers general hypospadias information, perioperative expectations and a review of postoperative care. DISCUSSION To our knowledge, this is the first DA prototype developed for a pediatric urology condition using a human-centered design approach to engage many key stakeholders in the development process. One limitation of this study is the small population sampled, which limits generalizability and means that our findings may not reflect the views of all parents or pediatric providers involved in hypospadias decision-making. CONCLUSIONS We created a parent-centered hypospadias DA prototype that provides decision support in an online, interactive format. Future directions include further testing with usability experts, providers and parents.
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Affiliation(s)
- Katherine H Chan
- Department of Urology, Indiana University School of Medicine, Indianapolis, IN, USA; Center for Pediatric and Adolescent Comparative Effectiveness Research, Department of Pediatrics, Indiana University School of Medicine, Indianapolis, IN, USA; Department of Medicine, Indiana University School of Medicine, Indianapolis, IN, USA.
| | - Rosalia Misseri
- Department of Urology, Indiana University School of Medicine, Indianapolis, IN, USA.
| | - Aaron Carroll
- Center for Pediatric and Adolescent Comparative Effectiveness Research, Department of Pediatrics, Indiana University School of Medicine, Indianapolis, IN, USA.
| | - Richard Frankel
- Department of Medicine, Indiana University School of Medicine, Indianapolis, IN, USA; Cleveland Clinic Learner Institute, Cleveland, OH, USA.
| | - Courtney M Moore
- Research Jam, Indiana Clinical and Translational Sciences Institute, Indianapolis, IN, USA.
| | - Brandon Cockrum
- Research Jam, Indiana Clinical and Translational Sciences Institute, Indianapolis, IN, USA.
| | - Sarah E Wiehe
- Children's Health Services Research, Indiana University School of Medicine, Indianapolis, IN, USA; Research Jam, Indiana Clinical and Translational Sciences Institute, Indianapolis, IN, USA.
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Chan KH, Misseri R, Cain MP, Whittam B, Szymanski K, Kaefer M, Rink R, Cockrum B, Moore C, Wiehe S. Provider perspectives on shared decision-making regarding hypospadias surgery. J Pediatr Urol 2020; 16:307-315. [PMID: 32307325 PMCID: PMC8562057 DOI: 10.1016/j.jpurol.2020.03.015] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2020] [Accepted: 03/19/2020] [Indexed: 01/23/2023]
Abstract
INTRODUCTION Many parents experience decisional conflict and decisional regret around hypospadias surgery. The utilization of a shared decision-making (SDM) process may mitigate these issues, however addressing the principal components of the SDM process is a complex task that requires the investment of providers. OBJECTIVE The purpose of this study was to facilitate a discussion about SDM anchored on hypospadias with pediatric urology and general pediatric providers to explore perspectives, clinical applications and barriers to adopting SDM in clinical practice. STUDY DESIGN We conducted two focus groups in order to engage pediatric urology and general pediatric providers in guided discussions about SDM anchored on hypospadias. All activities were audio recorded and professionally transcribed. The transcripts were analyzed by three coders using directed qualitative content analysis techniques to identify themes and relationships between themes to inform the development of an affinity diagram (Extended Summary Figure). RESULTS Two focus groups were held; one with seven pediatric urology providers in November 2018 and one with ten general pediatric providers in January 2019 (median age 51 years, 88.2% Caucasian, 58.8% female, 70.6% physicians and 29.4% nurse practitioners). Both groups identified some of the key components of SDM including engaging families in decision-making, informing them about treatment options and clarifying values/preferences (Extended Summary Figure). They thought that SDM was useful for discussing preference-sensitive conditions (e.g. hypospadias) and addressing parental compliance. General pediatric providers also suggested that SDM helped them avoid unnecessary referrals to specialists. Both groups identified parental, provider and systemic barriers to the adoption of SDM: a) desire for paternalism, b) misperceptions about medical evidence, c) completion of parental decision-making prior to the clinical visit, d) provider bias/lack of interest and e) time constraints/productivity pressures. DISCUSSION Providers who care for hypospadias patients are knowledgeable about SDM and its potential clinical applications. They identified several potentially modifiable barriers to the adoption of a SDM process about hypospadias surgery in a pediatric clinical setting. CONCLUSIONS Based on feedback from providers, we plan to implement a hypospadias decision aid early in the parental decision-making process about hypospadias such as in the postpartum unit and at well-child visits in the newborn period and provide a provider training session about SDM to address the identified knowledge gaps.
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Affiliation(s)
- Katherine H Chan
- Department of Urology, Indiana University School of Medicine, Indianapolis, IN, USA; Department of Pediatrics, Center for Pediatric and Adolescent Comparative Effectiveness Research, Indiana University School of Medicine, Indianapolis, IN, USA.
| | - Rosalia Misseri
- Department of Urology, Indiana University School of Medicine, Indianapolis, IN, USA.
| | - Mark P Cain
- Department of Urology, University of Washington, Seattle, WA, USA.
| | - Benjamin Whittam
- Department of Urology, Indiana University School of Medicine, Indianapolis, IN, USA.
| | - Konrad Szymanski
- Department of Urology, Indiana University School of Medicine, Indianapolis, IN, USA.
| | - Martin Kaefer
- Department of Urology, Indiana University School of Medicine, Indianapolis, IN, USA.
| | - Richard Rink
- Department of Urology, Indiana University School of Medicine, Indianapolis, IN, USA.
| | - Brandon Cockrum
- Research Jam, Indiana Clinical and Translational Sciences Institute, Indiana University School of Medicine, Indianapolis, IN, USA.
| | - Courtney Moore
- Research Jam, Indiana Clinical and Translational Sciences Institute, Indiana University School of Medicine, Indianapolis, IN, USA.
| | - Sarah Wiehe
- Research Jam, Indiana Clinical and Translational Sciences Institute, Indiana University School of Medicine, Indianapolis, IN, USA.
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Chan KH, Panoch J, Carroll A, Wiehe S, Cain MP, Frankel R. Knowledge gaps and information seeking by parents about hypospadias. J Pediatr Urol 2020; 16:166.e1-166.e8. [PMID: 32061490 PMCID: PMC8562056 DOI: 10.1016/j.jpurol.2020.01.008] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2019] [Accepted: 01/14/2020] [Indexed: 10/25/2022]
Abstract
INTRODUCTION Parents making complex decisions about hypospadias surgery may experience anxiety and uncertainty related to multiple sources of information with questionable reliability and limited relevance to their concerns. OBJECTIVE The purpose of this study was to identify knowledge gaps, information-seeking behaviors, and informational needs of parents making decisions about hypospadias surgery as an initial step in the development of a hypospadias decision aid. STUDY DESIGN We conducted semi-structured interviews with English-speaking parents (≥18 years of age) of children with hypospadias, inquiring about gaps in their knowledge, information-seeking behaviors, and perceived informational needs (Extended Summary Table). We conducted interviews until no new themes were identified, analyzing them iteratively using open, axial, and selective coding. We used grounded theory methods to develop an explanation of the information-seeking process about hypospadias surgery. RESULTS Of the 43 eligible parents, 16 mothers and 1 father (39.5%) of 16 patients participated: 7 preoperative and 9 postoperative with distal (8) and proximal (8) meatal locations. Parents were aged 21-43: 15 Caucasians and 2 African-Americans. Educational backgrounds and marital status varied across subjects. We identified five categories of knowledge gaps relating to hypospadias surgery: 1) epidemiology, 2) timing/technique, 3) perioperative experience, 4) long-term cosmetic outcome, and 5) long-term risk of complications. Information-seeking behaviors included searching the internet, discussing hypospadias with the child's pediatrician and/or urologist, and obtaining information from their social network. Most parents sought information online prior to and/or after consultation with the urologist, from parent blogs/forums, medical school/hospital websites, journal articles, and medical databases. Perceived informational needs included clear and reliable information online, images of mild degrees of hypospadias, and images of repaired hypospadias cases. According to the parents, video testimonials from other parents would help them relate to others in their social network and build confidence about the surgical process. DISCUSSION The findings of this study contribute to our understanding of parental decision-making about hypospadias surgery by highlighting specific knowledge gaps and informational needs for inclusion in a decision aid. Study limitations include a small sample size that is typical and expected for qualitative research studies and the underrepresentation of fathers, minorities, and same-sex couples. CONCLUSIONS The Internet is the primary source of information most parents use to address knowledge gaps about hypospadias. Parents expressed concerns about the reliability and clarity of information and identified informational needs including parent testimonials and a wide variety of hypospadias images for inclusion in a decision aid.
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Affiliation(s)
- Katherine H Chan
- Department of Urology, Indiana University School of Medicine, USA; Department of Pediatrics, Center for Pediatric and Adolescent Comparative Effectiveness Research, USA.
| | - Janet Panoch
- Department of Urology, Indiana University School of Medicine, USA
| | - Aaron Carroll
- Department of Pediatrics, Center for Pediatric and Adolescent Comparative Effectiveness Research, USA
| | - Sarah Wiehe
- Department of Pediatrics, Children's Health Services Research, USA
| | - Mark P Cain
- Department of Urology, Indiana University School of Medicine, USA
| | - Richard Frankel
- Department of Medicine, Indiana University School of Medicine, Indianapolis, IN, USA; Cleveland Clinic Learner Institute, Cleveland, OH, USA
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Leunbach TL, O''Toole S, Springer A, Williamson PR, Ahmed SF. A Systematic Review of Core Outcomes for Hypospadias Surgery. Sex Dev 2019; 13:165-170. [DOI: 10.1159/000504973] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/11/2019] [Indexed: 01/30/2023] Open
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