Decision Making in Pediatric Plastic Surgery: Autonomy and Shared Approaches

Ranganathan, Kavitha; Luby, Alexandra O.; Haase, Madeleine; Matusko, Niki; Patterson, Anne; Makar, Katelyn G; Vercler, Christian J.; Kasten, Steven J.; Buchman, Steven R.; Waljee, Jennifer F.

doi:10.1097/scs.0000000000006738

Cited by 4 publications

(2 citation statements)

References 38 publications

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“…Clinicians and administrators may need to consider the unintended consequences arising from the policy that "mandates" PPIA and may not offer the appropriate preparation and support for PPIA. In addition, some parents or children may have no desire for PPIA as their child may be coping well or exercising their autonomy in medical-decision making with the parent's support [25][26][27][28].…”

Section: Discussionmentioning

confidence: 99%

Experiences of Parental Presence in the Induction of Anesthesia in a Canadian Tertiary Pediatric Hospital: A Cross-Sectional Study

Garcia-Tejedor¹,

Le²,

Tackey³

et al. 2023

Cureus

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BackgroundParental presence at induction of anesthesia remains controversial and has been reported to provide mixed results. As such, parental presence at induction of anesthesia is not practiced routinely everywhere. There are currently limited data describing the practice of parental presence at induction of anesthesia or the experiences and perceptions of parents in Canada. ObjectivesWe sought to investigate (1) the frequency of parental presence at induction of anesthesia and (2) the experiences and perceptions of parents accompanying their child into the operating room compared to those who did not at a tertiary Canadian pediatric hospital. MethodsInstitutional quality improvement approval was obtained. This study was a cross-sectional survey. Parents waiting in the parent surgical waiting room during the procedure were invited to complete a web-based survey. Consent was implied via completing the survey. The cross-sectional survey elicited the prevalence of parental presence during induction of anesthesia as well as their experience and perceptions. We also investigated the parents' preferences for preoperative education.

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Section: Discussionmentioning

confidence: 99%

Experiences of Parental Presence in the Induction of Anesthesia in a Canadian Tertiary Pediatric Hospital: A Cross-Sectional Study

Garcia-Tejedor¹,

Le²,

Tackey³

et al. 2023

Cureus

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“…Patients and families desire SDM during procedural care. Recent work in pediatric plastic surgery found that 40% of patients and 67% of caregivers wanted active engagement in their care through SDM [15 ▪ ]. Importantly, the presenting diagnosis in this study included dermatologic issues (neoplasms and scars) 40% of the time.…”

Section: Current Use Of Shared Decision Making In Pediatricsmentioning

confidence: 98%

Shared decision making in pediatric dermatology: context, opportunities, and practical examples

Kozina¹,

Politi

Coughlin

2021

Current Opinion in Pediatrics

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Purpose of review Shared decision making (SDM) is an important part of patient-centered care. However, it is neither widely practiced nor researched in pediatric dermatology. In this article, we provide practical examples of how to engage in SDM in pediatric dermatology, and identify future areas of research. Recent findings Children and parents/guardians desire SDM in clinical encounters. The process is applicable to discussions of medical as well as surgical care. Additionally, SDM can help prepare children for the transition from pediatric to adult/general providers. Clinicians often want more guidance on its implementation, and there is a dearth of research on SDM or decision tools specific to pediatric dermatology. Summary SDM is underused and understudied in pediatric dermatology. This article highlights how to engage in SDM and presents opportunities for research and implementation in pediatric dermatology.

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Ethical Implications of Cleft Lip and Palate Repair in Patients with Trisomy 13 and Trisomy 18

Appel

Grush

Upadhyaya

et al. 2023

The Cleft Palate Craniofacial Journal

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Background Children born with Trisomy 13 or 18 (T13/18) often have multiple congenital anomalies, many of which drastically shorten their lifespan. Among these defects are cleft lip and palate, the repair of which presents an ethical dilemma to the surgeon given the underlying comorbidities associated with T13/18. The authors present an ethical discussion and institutional experience in navigating this dilemma. Methods The authors analyzed existing literature on T13 and T18 surgery and mortality. A retrospective study over ten years was also conducted to identify pediatric patients who underwent surgical correction of cleft lip and/or palate secondary to a confirmed diagnosis of T13/18. The authors identified two patients and examined their treatment course. Results The authors’ review of literature coupled with their institution's experience builds on the published successes of correcting cleft lip and palate in the setting of T13/18. It was found that both patients identified in the case series underwent successful correction with no surgical complications. Conclusion A careful balance must be struck between improved quality of life, benefits of treatment, and risks of surgery in children with T13/T18. Careful consideration should be given to the medical status of these complex patients. If the remaining medical comorbidities are well managed and under control, there is an ethical precedent for performing cleft lip and palate surgeries on these children. A diagnosis of T13/T18 alone is not enough to disqualify patients from cleft lip/palate surgery.

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Decision Making in Pediatric Plastic Surgery: Autonomy and Shared Approaches

Cited by 4 publications

References 38 publications

Experiences of Parental Presence in the Induction of Anesthesia in a Canadian Tertiary Pediatric Hospital: A Cross-Sectional Study

Experiences of Parental Presence in the Induction of Anesthesia in a Canadian Tertiary Pediatric Hospital: A Cross-Sectional Study

Shared decision making in pediatric dermatology: context, opportunities, and practical examples

Ethical Implications of Cleft Lip and Palate Repair in Patients with Trisomy 13 and Trisomy 18

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