Barriers and Facilitators to Parental Shared Decision Making for Adenotonsillectomy and Tympanostomy Tube Placement.

Abstract

To identify barriers and facilitators to parents' participation in shared decision making (SDM) for adenotonsillectomy or tympanostomy tube surgeries. A qualitative study. Semi-structured interviews with parents who had attended a surgical consultation to discuss adeno/tonsillectomy or tympanostomy tube placement for their child. Data were analyzed using the Theoretical Domains Framework to identify behavioural determinants related to parents' capability, opportunity, and motivation for engaging in SDM. Thematic coding of interviews was performed by 2 separate reviewers. A total of 11 interviews were conducted. Data saturation was confirmed following thematic analysis. Themes were grouped into 4 meta-themes identifying dominant factors shaping parents' participation in SDM: (1) Having adequate information about the condition and available options, (2) Having time to consider and discuss the decision beyond the initial consultation, (3) The demeanor of the surgeon, and (4) Comfort participating in decision-making. Parents agree that SDM is a good ideal for guiding consultations about adeno/tonsillectomy or tympanostomy tube surgery, but not all parents prefer the same role in decision-making. Parents are not equally aware of treatment options before or after attending a consultation, and their comfort discussing options is impacted by surgeons' behaviour. Design of SDM supports for this clinical context would beneficially include provision of information before the consultation, tools to support explicit and supportive conversation about parents' preferences and treatment options, and clinical infrastructure for continued communication and emotional support after the consultation.