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Shared decision-making in pediatric surgery: An overview of its application for the treatment of uncomplicated appendicitis

  • Kelli N. Patterson
    Affiliations
    Center for Surgical Outcomes Research, Abigail Wexner Research Institute at Nationwide Children's Hospital, 700 Children's Drive, Columbus, OH 43205, USA
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  • Katherine J. Deans
    Affiliations
    Department of Surgery, Nemours Children's Health Delaware, 1600 Rockland Rd, Wilimington, DE 19803, USA
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  • Peter C. Minneci
    Correspondence
    Corresponding author at: Nationwide Children's Hospital, Department of Pediatric Surgery, 700 Children's Drive, Columbus, OH 43205-2664, USA.
    Affiliations
    Center for Surgical Outcomes Research, Abigail Wexner Research Institute at Nationwide Children's Hospital, 700 Children's Drive, Columbus, OH 43205, USA

    Division of Pediatric Surgery, Nationwide Children's Hospital, 700 Children's Drive, Columbus, OH 43205, USA
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      Highlights

      • Shared decision-making is critical to patient-centered care in pediatric surgery.
      • Shared decision-making can be performed effectively in a high acuity surgical setting in children.
      • Treatment choice requires timely, informed decisions that allow for incorporation of personal values, and preferences.
      • Nonoperative management of uncomplicated appendicitis is an effective treatment alternative that maybe preferred by families.

      Abstract

      Nonoperative management (NOM) of uncomplicated appendicitis is a safe and effective treatment alternative to surgery that may be preferred by some families. Surgery and NOM differ significantly in their associated risks and benefits. Choosing a treatment for acute appendicitis requires patients and their caregivers to make timely, informed decisions that allow for incorporation of personal perspectives, values, and preferences. This article will address the concept of shared decision-making and establish its role in patient-centered care. It will demonstrate the effectiveness of shared decision-making in a high acuity surgical setting for children and highlight how the choice for management of acute appendicitis may be impacted by patients’ and families’ individualized circumstances and values.

      Keywords

      Abbreviations:

      NOM (nonoperative management)
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      References

        • Kassner E.G.
        • Mutchler R.W.
        • Klotz D.H.
        • Rose J.S.
        Uncomplicated foreign bodies of the appendix in children: radiologic observations.
        J Pediatr Surg. 1974; 9: 207-211
        • Addiss D.G.
        • Shaffer N.
        • Fowler B.S.
        • Tauxe R.V.
        The Epidemiology of Appendicitis and Appendectomy in the United States.
        Am J Epidemiol. 1990; 132: 910-925
        • Fitz R.
        Perforating inflammation of the vermiform appendix with special reference to its early diagnosis and treatment.
        Trans Assoc Am Physicians. 1886; 1: 107-144
        • Broderick-Villa G.
        • Burchette R.J.
        • Collins J.C.
        • Abbas M.A.
        • Haigh P.I.
        Hospitalization for acute diverticulitis does not mandate routine elective colectomy.
        Arch Surg. 2005; 140: 576-583
        • Mosuka E.M.
        • Thilakarathne K.N.
        • Mansuri N.M.
        • Mann N.K.
        • Rizwan S.
        • Mohamed A.E.
        • et al.
        A systematic review comparing nonoperative management to appendectomy for uncomplicated appendicitis in children.
        Cureus. 2021; 13: e18901
        • Barry M.J.
        • Edgman-Levitan S.
        Shared decision making–pinnacle of patient-centered care.
        N Engl J Med. 2012; 366: 780-781
        • Charles C.
        • Gafni A.
        • Whelan T.
        Shared decision-making in the medical encounter: what does it mean?(or it takes at least two to tango).
        Soc Sci Med. 1997; 44: 681-692
        • Elwyn G.
        • Frosch D.
        • Thomson R.
        • Joseph-Williams N.
        • Lloyd A.
        • Kinnersley P.
        • et al.
        Shared decision making: a model for clinical practice.
        J Gen Intern Med. 2012; 27: 1361-1367
        • Braddock 3rd., C.H.
        The emerging importance and relevance of shared decision making to clinical practice.
        Med Decis Making. 2010; 30: 5s-7s
        • Shinkunas L.A.
        • Klipowicz C.J.
        • Carlisle E.M.
        Shared decision making in surgery: a scoping review of patient and surgeon preferences.
        BMC Med Inform Decis Mak. 2020; 20: 190
        • Szasz T.S.
        • Hollender M.H.
        A contribution to the philosophy of medicine: the basic models of the doctor-patient relationship.
        AMA Arch Int Med. 1956; 97: 585-592
        • Pieterse A.H.
        • Finset A.
        Shared decision making-Much studied, much still unknown.
        Patient Educ Couns. 2019; 102: 1946-1948
        • Hack T.F.
        • Degner L.F.
        • Dyck D.G.
        Relationship between preferences for decisional control and illness information among women with breast cancer: a quantitative and qualitative analysis.
        Soc Sci Med. 1994; 39: 279-289
        • Degner L.F.
        • Sloan J.A.
        Decision making during serious illness: what role do patients really want to play?.
        J Clin Epidemiol. 1992; 45: 941-950
        • Vertinsky I.B.
        • Thompson W.A.
        • Uyeno D.
        Measuring consumer desire for participation in clinical decision making.
        Health Serv Res. 1974; 9: 121-134
        • Hower E.G.
        Beyond Shared Decision Making.
        J Clin Ethics. 2020; 31: 293-302
        • Bouniols N.
        • Leclère B.
        • Moret L.
        Evaluating the quality of shared decision making during the patient-carer encounter: a systematic review of tools.
        BMC Res Notes. 2016; 9: 382
        • Gärtner F.R.
        • Bomhof-Roordink H.
        • Smith I.P.
        • Scholl I.
        • Stiggelbout A.M.
        • Pieterse A.H.
        The quality of instruments to assess the process of shared decision making: a systematic review.
        PLoS ONE. 2018; 13e0191747
        • Woltz S.
        • Krijnen P.
        • Pieterse A.H.
        • Schipper I.B.
        Surgeons’ perspective on shared decision making in trauma surgery. A national survey.
        Patient Educ Couns. 2018; 101: 1748-1752
        • Bomhof-Roordink H.
        • Gärtner F.R.
        • Stiggelbout A.M.
        • Pieterse A.H.
        Key components of shared decision making models: a systematic review.
        BMJ Open. 2019; 9e031763
        • Forner D.
        • Noel C.W.
        • Shuman A.G.
        • Hong P.
        • Corsten M.
        • Rac V.E.
        • et al.
        Shared decision-making in head and neck surgery: a review.
        JAMA Otolaryngol Head Neck Surg. 2020; 146: 839-844
        • Samanta D.
        • Hoyt M.L.
        • Perry M.S.
        Parental experience and decision-making for epilepsy surgery: a systematic review of qualitative and quantitative studies.
        Epilepsy Behav. 2021; 123108263
        • Boss E.F.
        • Mehta N.
        • Nagarajan N.
        • Links A.
        • Benke J.R.
        • Berger Z.
        • et al.
        Shared decision making and choice for elective surgical care: a systematic review.
        Otolaryngol Head Neck Surg. 2016; 154: 405-420
        • Carlisle E.M.
        • Shinkunas L.A.
        • Kaldjian L.C.
        Do surgeons and patients/parents value shared decision-making in pediatric surgery? A systematic review.
        J Surg Res. 2018; 231: 49-53
        • Thomas C.M.
        • Sklar M.C.
        • Su J.
        • Xu W.
        • de Almeida J.R.
        • Gullane P.
        • et al.
        Evaluation of older age and frailty as factors associated with depression and postoperative decision regret in patients undergoing major head and neck surgery.
        JAMA Otolaryngology–Head & Neck Surgery. 2019; 145: 1170-1178
        • Stacey D.
        • Légaré F.
        • Lewis K.
        • Barry M.J.
        • Bennett C.L.
        • Eden K.B.
        • et al.
        Decision aids for people facing health treatment or screening decisions.
        Cochrane Database of Syst Rev. 2017;
        • O'Connor A.M.
        • Llewellyn-Thomas H.A.
        • Flood A.B.
        Modifying unwarranted variations in health care: shared decision making using patient decision aids.
        Health Aff (Millwood). 2004; : Var63-Var72
        • Lurie J.D.
        • Spratt K.F.
        • Blood E.A.
        • Tosteson T.D.
        • Tosteson A.N.
        • Weinstein J.N.
        Effects of viewing an evidence-based video decision aid on patients' treatment preferences for spine surgery.
        Spine (Phila Pa 1976). 2011; 36: 1501-1504
        • Spunt B.S.
        • Deyo R.A.
        • Taylor V.M.
        • Leek K.M.
        • Goldberg H.I.
        • Mulley A.G.
        An interactive videodisc program for low back pain patients.
        Health Educ Res. 1996; 11: 535-541
        • Stacey D.
        • Hawker G.
        • Dervin G.
        • Tugwell P.
        • Boland L.
        • Pomey M.P.
        • et al.
        Decision aid for patients considering total knee arthroplasty with preference report for surgeons: a pilot randomized controlled trial.
        BMC Musculoskelet Disord. 2014; 15: 54
        • Minneci P.C.
        • Hade E.M.
        • Lawrence A.E.
        • Saito J.M.
        • Mak G.Z.
        • Hirschl R.B.
        • et al.
        Multi-institutional trial of non-operative management and surgery for uncomplicated appendicitis in children: design and rationale.
        Contemp Clin Trials. 2019; 83: 10-17
        • Minneci P.C.
        • Hade E.M.
        • Lawrence A.E.
        • Sebastiao Y.V.
        • Saito J.M.
        • Mak G.Z.
        • et al.
        Association of nonoperative management using antibiotic therapy vs laparoscopic appendectomy with treatment success and disability days in children with uncomplicated appendicitis.
        JAMAJAMA. 2020; 324: 581-593
        • Zikmund-Fisher B.J.
        • Sarr B.
        • Fagerlin A.
        • Ubel P.A.
        A matter of perspective: choosing for others differs from choosing for yourself in making treatment decisions.
        J Gen Intern Med. 2006; 21: 618-622
        • Lipstein E.A.
        • Brinkman W.B.
        • Britto M.T.
        What is known about parents' treatment decisions? A narrative review of pediatric decision making.
        Med Decis Making. 2012; 32: 246-258
        • Fiks A.G.
        • Jimenez M.E.
        The promise of shared decision-making in paediatrics.
        Acta Paediatr. 2010; 99: 1464-1466
        • Gabe J.
        • Olumide G.
        • Bury M.
        'It takes three to tango': a framework for understanding patient partnership in paediatric clinics.
        Soc Sci Med. 2004; 59: 1071-1079
        • Rhodes R.
        • Holzman I.R.
        Is the best interest standard good for pediatrics?.
        PediatricsPediatrics. 2014; 134 Suppl 2: S121-S129
        • Sulmasy D.P.
        • Snyder L.
        Substituted interests and best judgments: an integrated model of surrogate decision making.
        JAMAJAMA. 2010; 304: 1946-1947
        • Katz A.L.
        • Webb S.A.
        • Committee On B.
        • Macauley R.C.
        • Mercurio M.R.
        • Moon M.R.
        • et al.
        Informed consent in decision-making in pediatric practice.
        PediatricsPediatrics. 2016; 138e20161485
        • McKenna K.
        • Collier J.
        • Hewitt M.
        • Blake H.
        Parental involvement in paediatric cancer treatment decisions.
        Eur J Cancer Care (Engl). 2010; 19: 621-630
        • Götz I.
        • Labenbacher I.
        • Eichler I.
        • Wojnarowski C.
        • Götz M.
        Health-independent lung transplantation information of parents of children with cystic fibrosis.
        TransplantationTransplantation. 1997; 64: 742-747
        • Grady C.
        • Wiener L.
        • Abdoler E.
        • Trauernicht E.
        • Zadeh S.
        • Diekema D.S.
        • et al.
        Assent in research: the voices of adolescents.
        J Adolesc Health. 2014; 54: 515-520
        • Britto M.T.
        • DeVellis R.F.
        • Hornung R.W.
        • DeFriese G.H.
        • Atherton H.D.
        • Slap G.B.
        Health care preferences and priorities of adolescents with chronic illnesses.
        PediatricsPediatrics. 2004; 114: 1272-1280
        • Coyne I.
        • Gallagher P.
        Participation in communication and decision-making: children and young people's experiences in a hospital setting.
        J Clin Nurs. 2011; 20: 2334-2343
        • Curtis K.
        • Liabo K.
        • Roberts H.
        • Barker M.
        Consulted but not heard: a qualitative study of young people's views of their local health service.
        Health Expect. 2004; 7: 149-156
        • Wassmer E.
        • Minnaar G.
        • Abdel Aal N.
        • Atkinson M.
        • Gupta E.
        • Yuen S.
        • et al.
        How do paediatricians communicate with children and parents?.
        Acta Paediatr. 2004; 93: 1501-1506
        • Angst D.B.
        • Deatrick J.A.
        Involvement in health care decisions: parents and children with chronic illness.
        J Fam Nurs. 1996; 2: 174-194
        • Tieffenberg J.
        • Wood E.
        • Alonso A.
        • Tossutti M.
        • Vicente M.
        A randomized field trial of ACINDES: a child-centered training model for children with chronic illnesses (asthma and epilepsy).
        J Urban Health. 2000; 77: 280-297
        • de Winter M.
        • Baerveldt C.
        • Kooistra J.
        Enabling children: participation as a new perspective on child-health promotion.
        Child Care Health Dev. 1999; 25 (discussion -5): 15-23
        • Alderson P.
        • Sutcliffe K.
        • Curtis K.
        Children as partners with adults in their medical care.
        Arch Dis Child. 2006; 91: 300-303
        • Sutcliffe K.
        • Alderson P.
        • Curtis K.
        • Close B.
        Children as partners in their diabetes care.
        ChildrenChildren. 2004;
        • Sloper P.
        • Lightfoot J.
        Involving disabled and chronically ill children and young people in health service development.
        Child Care Health Dev. 2003; 29: 15-20
        • Minneci P.C.
        • Sulkowski J.P.
        • Nacion K.M.
        • Mahida J.B.
        • Cooper J.N.
        • Moss R.L.
        • et al.
        Feasibility of a nonoperative management strategy for uncomplicated acute appendicitis in children.
        J Am Coll Surg. 2014; 219: 272-279
        • Varadhan K.K.
        • Neal K.R.
        • Lobo D.N.
        Safety and efficacy of antibiotics compared with appendicectomy for treatment of uncomplicated acute appendicitis: meta-analysis of randomised controlled trials.
        BMJ. 2012; 344
        • Wilms I.M.
        • De Hoog D.E.
        • de Visser D.C.
        • Janzing H.M.
        Appendectomy versus antibiotic treatment for acute appendicitis.
        Cochrane Database Syst Rev. 2011;
        • Huang L.
        • Yin Y.
        • Yang L.
        • Wang C.
        • Li Y.
        • Zhou Z.
        Comparison of antibiotic therapy and appendectomy for acute uncomplicated appendicitis in children: a meta-analysis.
        JAMA Pediatr. 2017; 171: 426-434
        • Chappuy H.
        • Taupin P.
        • Dimet J.
        • Claessens Y.E.
        • Tréluyer J.-.M.
        • Chéron G.
        • et al.
        Do parents understand the medical information provided in paediatric emergency departments? A prospective multicenter study.
        Acta Paediatr. 2012; 101: 1089-1094
        • Horowitz L.
        • Kassam-Adams N.
        • Bergstein J.
        Mental health aspects of emergency medical services for children: summary of a consensus conference.
        J Pediatr Psychol. 2001; 26: 491-502
        • Kassam-Adams N.
        • Fleisher C.L.
        • Winston F.K.
        Acute stress disorder and posttraumatic stress disorder in parents of injured children.
        J Trauma Stress. 2009; 22: 294-302
        • Schaeffer M.H.
        • Krantz D.S.
        • Wichman A.
        • Masur H.
        • Reed E.
        • Vinicky J.K.
        The impact of disease severity on the informed consent process in clinical research.
        Am J Med. 1996; 100: 261-268
        • Katan M.
        • Christ-Crain M.
        The stress hormone copeptin: a new prognostic biomarker in acute illness.
        Swiss Med Wkly. 2010; 140: w13101
        • Smithline H.A.
        • Mader T.J.
        • Crenshaw B.J.
        Do patients with acute medical conditions have the capacity to give informed consent for emergency medicine research?.
        Acad Emerg Med. 1999; 6: 776-780
        • Wray J.
        • Lee K.
        • Dearmun N.
        • Franck L.
        Parental anxiety and stress during children's hospitalisation: the StayClose study.
        J Child Health Care. 2011; 15: 163-174
        • Clarke C.
        • Friedman S.M.
        • Shi K.
        • Arenovich T.
        • Monzon J.
        • Culligan C.
        Emergency department discharge instructions comprehension and compliance study.
        Can J Emerg Med. 2005; 7: 5-11
        • Crane J.A.
        Patient comprehension of doctor-patient communication on discharge from the emergency department.
        J Emerg Med. 1997; 15: 1-7
        • La Vonne A.D.
        • Zun L.S.
        The correlation between patient comprehension of their reason for hospital admission and overall patient satisfaction in the emergency department.
        J Natl Med Assoc. 2010; 102: 637-643
        • Waisman Y.
        • Siegal N.
        • Chemo M.
        • Siegal G.
        • Amir L.
        • Blachar Y.
        • et al.
        Do parents understand emergency department discharge instructions? A survey analysis.
        IMAJ-RAMAT GAN-. 2003; 5: 567-570
        • Massoumi R.L.
        • Dubrovsky G.
        • Nguyen M.
        • Gomez C.
        • Blahut M.
        • Sacks G.D.
        • et al.
        Parental attitudes towards choosing between operative and nonoperative management of pediatric acute appendicitis.
        J Pediatr Surg. 2021;
        • Pescosolido B.A.
        Beyond rational choice: the social dynamics of how people seek help.
        Am J Sociol. 1992; 97: 1096-1138
        • Leslie L.K.
        • Plemmons D.
        • Monn A.R.
        • Palinkas L.A.
        Investigating ADHD treatment trajectories: listening to families' stories about medication use.
        J Dev Behav Pediatr. 2007; 28: 179-188
        • O'Connor A.M.
        • Bennett C.L.
        • Stacey D.
        • Barry M.
        • Col N.F.
        • Eden K.B.
        • et al.
        Decision aids for people facing health treatment or screening decisions.
        Cochrane Database Syst Rev. 2009;
        • Niburski K.
        • Guadagno E.
        • Abbasgholizadeh-Rahimi S.
        • Poenaru D.
        Shared decision making in surgery: a meta-analysis of existing literature.
        Patient. 2020; 13: 667-681
        • Joosten E.A.
        • DeFuentes-Merillas L.
        • de Weert G.H.
        • Sensky T.
        • van der Staak C.P.
        • de Jong C.A.
        Systematic review of the effects of shared decision-making on patient satisfaction, treatment adherence and health status.
        Psychother Psychosom. 2008; 77: 219-226
        • Stacey D.
        • Légaré F.
        • Col N.F.
        • Bennett C.L.
        • Barry M.J.
        • Eden K.B.
        • et al.
        Decision aids for people facing health treatment or screening decisions.
        Cochrane Database Syst Rev. 2014;
        • Minneci P.C.
        • Hade E.M.
        • Gil L.A.
        • Metzger G.A.
        • Saito J.M.
        • Mak G.Z.
        • et al.
        Demographic and clinical characteristics associated with the failure of nonoperative management of uncomplicated appendicitis in children: secondary analysis of a nonrandomized clinical trial.
        JAMA Netw Open. 2022; 5e229712
        • Hanson A.L.
        • Crosby R.D.
        • Basson M.D.
        Patient preferences for surgery or antibiotics for the treatment of acute appendicitis.
        JAMA Surg. 2018; 153: 471-478
        • Ensor N.
        • Qin K.R.
        • Sivasubramaniam M.
        • Roddis B.
        • Mayakaduwage K.
        • Pacilli M.
        • et al.
        Parental views on the non-operative management of simple appendicitis in children: results of a cross-sectional survey.
        World J Surg. 2022; 46: 274-287
        • Brahmamdam P.
        • Carveth S.L.
        • Smyth M.
        • Gendelman B.S.
        • Maisels M.J.
        Factors influencing choice of medical vs. Surgical treatment of pediatric appendicitis.
        J Pediatr Surg. 2019; 54: 1800-1803