49 - Parent perspectives on shared decision making in the care of febrile infants

Poster Number: 49
Publication Number: 49.112

Jennifer Savitz, Children's Hospital Los Angeles, Los Angeles, CA, United States; Angela Y. Choe, Children’s Hospital Los Angeles, Los Angeles, CA, United States; Sandy G. Andres, Children's Hospital Los Angeles, Los Angeles, CA, United States; My H. Vu, Children's Hospital Los Angeles, Los Angeles, CA, United States; Sabrina F. Derrington, Children's Hospital Los Angeles, Los Angeles, CA, United States

Background: The 2021 American Academy of Pediatrics (AAP) clinical practice guidelines for management of well-appearing febrile infants include new recommendations for shared decision making (SDM) with parents in clinical scenarios with insufficient data to support a single management option. The parent experience engaging in SDM during an acute illness, particularly for non-English speaking parents, has not been well described.

Objective: Explore parent views on priorities and challenges to SDM in the care of febrile infants

Design/Methods: This single center, mixed methods study included English and Spanish-speaking parents of term, well-appearing febrile infants presenting to the Emergency Department. Parents of infants whose clinical scenarios met criteria for SDM per the 2021 AAP guidelines were included. Parents completed the validated SDM Q9 survey, which assesses parent agreement that core elements of SDM occurred. Qualitative data was collected through in-depth, semi-structured interviews with parents, exploring their experiences with decision making and communication preferences. Interview data was inductively coded by multiple team members using the constant comparative method; codes were revised to ensure agreement and themes were developed.

Results: 14 parents of 11 infants (all 29-60 days old with elevated inflammatory markers) consented to participation. Most families had Medicaid insurance and lived in neighborhoods with “very low” Child Opportunity Index. Most common discharge diagnosis was urinary tract infection, and the sample included 2 infants with bacteremia or meningitis (Table 1). Mean SDM Q9 score (out of 100) for English-speaking parents was 62.54 (SD 27.08) and for Spanish-speaking parents was 61.94 (SD 47.30) (p=0.7). Parents identified multiple SDM opportunities throughout the illness course, including but not limited to decisions about lumbar puncture and disposition. Perceived role in decision making ranged from unilateral physician decision making to parents guiding the final decision. Parents considered several factors when weighing risks and benefits during decision making. Major themes for parent priorities in SDM included time to consider clear options and clinicians valuing parent perspectives. Challenges to SDM included parent self-doubt and disagreement in infant assessment (Table 2).

Conclusion(s): Parents of febrile infants perceive engagement in decision making as a substantial responsibility, but also value education on all available options for treatment. Eliciting individual parent values and assessment may facilitate improved communication about treatment options.