Patient Decision Aid Useful for Parents Offered Tonsillectomy for Their Children with Obstructive Sleep Apnea

by Linda Kossoff •

How will a novel patient decision aid (PtDA) for parents considering tonsillectomy for their children diagnosed with obstructive sleep apnea (OSA) compare with validated scales related to decision making in this context?

BOTTOM LINE

As compared to validated scales, the novel PtDA can reduce decisional conflict (DC) and shows potential use for parents.

BACKGROUND: Patient-centered care and shared decision making (SDM) are important for parents considering elective surgeries for their children. For parents/ guardians of children with OSA, making decisions about the course of their child’s elective treatment can create DC, leading to anxiety and decision delay and, potentially, postoperative decisional regret (DR).

STUDY DESIGN: Prospective study and surveys.

SETTING: Department of Otolaryngology, West Virginia University, Morgantown, W.Va.

SYNOPSIS: Researchers enrolled 89 parents of pediatric patients (mean age 5.6 years) recently diagnosed with OSA, who presented to a tertiary care pediatric otolaryngology clinic from 2017 to 2018. The parental decision to pursue surgery was established upon a 15-minute surgical consultation. Parents were then asked to answer paper-based surveys containing multiple sections gauging their decision quality (DQ), or value of a decision when it is made, and their DC, an intrapersonal psychological construct felt by individuals when facing decisions that involve risk, loss, regret, or challenges to personal values. The researchers sought to compare a validated Decisional Conflict Scale with a new PtDA that included an SDM scale, assessment of values, and a closed-ended knowledge test about adenotonsillectomy and OSA. Results of the novel PtDA showed a mean DC score of 4.32 (range 0.00-35.94) and a mean DQ score of 22.69 points out of 30, confirming an inverse relationship between DC and DQ, and supporting the PtDA’s potential utility as a clinical tool. Study limitations included the brevity of surveys and the exclusion of non-English-fluent patients.

CITATION: Williamson A, Newby M, Phillips D, et al. Development of a decision aid for parents who elect tonsillectomy for obstructive sleep apnea. Ann Otol Rhinol Laryngol. 2022;131:617–621.