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J Pediatr. 2019 Oct;213:149-154. doi: 10.1016/j.jpeds.2019.05.055. Epub 2019 Jun 26.

Parent-to-Parent Advice on Considering Spinal Fusion in Children with Neuromuscular Scoliosis.

Author information

1
Division of General Pediatrics, Boston Children's Hospital, Harvard Medical School, Boston, MA.
2
Division of General Pediatrics, Boston Children's Hospital, Harvard Medical School, Boston, MA. Electronic address: jay.berry@childrens.harvard.edu.
3
Cerebral Palsy Center, Boston Children's Hospital, Boston, MA.
4
Department of Orthopaedic Surgery, Boston Children's Hospital, Boston, MA.
5
Healthcare Systems Engineering Institute, Northeastern University, Boston, MA; North Shore Medical Center, Salem, MA.
6
Harvard TH Chan School of Public Health, Boston, MA.
7
Department of Medicine, Stanford University School of Medicine, Stanford, CA.

Abstract

OBJECTIVES:

To convey advice from families whose children recently underwent spinal fusion to families whose children are under consideration for initial spinal fusion for neuromuscular scoliosis and to providers who counsel families on this decision.

STUDY DESIGN:

We interviewed 18 families of children who underwent spinal fusion between August 2017 and January 2019 at a freestanding children's hospital. We conducted phone interviews a median of 65 (IQR 51-77) days after surgery. We audio recorded, transcribed, and coded (line-by-line) interviews using grounded theory by 2 independent reviewers, and discussed among investigators to induce themes associated with surgical decision making and preparation.

RESULTS:

Six themes emerged about decision making and preparation for spinal fusion: (1) simplify risks and benefits; it is easy to get lost in the details; (2) families prolonging the decision whether or not to pursue spinal fusion surgery may not benefit the child; (3) anticipate anxiety and fear when making a decision about spinal fusion; (4) realize that your child might experience a large amount of pain; (5) anticipate a long recovery and healing process after spinal fusion; and (6) be engaged and advocate for your child throughout the perioperative spinal fusion process.

CONCLUSIONS:

Parents of children who had recently undergone spinal fusion had strong perceptions about what information to convey to families considering surgery, which may improve communication between future parents and physicians. Further investigation is needed to assess how best to incorporate the wisdom and experiences of parent peers into shared decision making and preparation for spinal fusion in children with neuromuscular scoliosis.

KEYWORDS:

children with medical complexity; parent advice; patient and family engagement; qualitative interviews; spinal fusion surgery

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