Physician perspectives on discussions with parents of infants with suspected ureteropelvic junction obstruction

Abstract

Introduction: The purpose of this study was to understand pediatric urologists' perceived role of patient characteristics on discussions about treatment of infants with suspected UPJ obstruction.

Methods: We conducted semi-structured interviews with pediatric urologists from three geographically diverse sites. Interview domains included: clinical indications for surgery, discussions with parents, and consideration of parent socioeconomic factors. Transcribed data and field notes were analyzed using a team-based, inductive grounded theory approach.

Results: Thirteen physicians were interviewed. Physicians reported a standardized approach to discussions to facilitate parental understanding. While they did not report overt consideration of demographics, they tailored discussions based on educational and cultural background and language barriers. Physicians also reported that concerns about risk of loss to follow up contributed to their treatment recommendations. Most physicians recognized that the lack of clear data often led to use of personal experience to guide recommendations.

Conclusion: Physicians recognize a gap in data to guide surgical decisions and utilize personal experience to augment this gap. They also recognize the influence of educational and language barriers on discussions with families and consider risk of loss to follow up when making recommendations, suggesting an implicit consideration of demographics. These findings suggest that development of evidence-based guidelines may reduce treatment variations.

Level of evidence: Not applicable (qualitative research study written in compliance with COREQ guidelines).

Keywords: Hydronephrosis; Surgical decision-making; Treatment variation; UPJ obstruction.

Figure 1.

Health Disparities Framework (adapted from A.M. Kilborne et al, Advancing health disparities research within the health care system: a conceptual framework [16])