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March 2017

Role of Qualitative Research in Shared Decision Making for Treatment of Sleep-Disordered BreathingPatients, Preferences, and Personal Factors

Author Affiliations
  • 1Department of Otolaryngology–Head and Neck Surgery, Washington University School of Medicine, St Louis, Missouri
JAMA Otolaryngol Head Neck Surg. 2017;143(3):213-214. doi:10.1001/jamaoto.2016.3364

Despite the prevalence of sleep-disordered breathing (SDB) and obstructive sleep apnea among children, the relative lack of evidence concerning their natural history, long-term consequences, predictors of outcome, and effectiveness of treatments leaves many gray areas for physicians, parents, and families to navigate. Adenotonsillectomy (AT) is commonly used to treat SDB but does not uniformly cure all of the related symptoms or prevent SDB from recurring and has known possible severe complications. Since the 1960s, researchers have observed large variations in rates of AT (≥13-fold in the 1960s; 5-fold in the 2000s) that continue to this day.1,2 A multitude of clinical practice guidelines and systematic reviews3 concludes that no one right answer exists for how to treat all children with SDB, yet parents must be counseled to make decisions for their children. Diverse specialists within and between subspecialties can recommend many treatment decisions regarding the care of patients with SDB, often without clear, definitive evidence, that may be confusing and bewildering to parents.4 Because so many ATs have been performed in this country, parents and families may have strong preferences for and against the choice of AT for their own children based on their personal familiarity with this procedure.

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