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Original Investigation
December 30, 2020

Assessment of Parental Choice Predisposition for Tonsillectomy in Children

Author Affiliations
  • 1Tufts University School of Medicine, Boston, Massachusetts
  • 2Department of Otolaryngology–Head and Neck Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
  • 3Department of Medicine, Johns Hopkins University, Baltimore, Maryland
  • 4Berman Institute of Bioethics, Johns Hopkins University, Baltimore, Maryland
JAMA Otolaryngol Head Neck Surg. Published online December 30, 2020. doi:10.1001/jamaoto.2020.5031
Key Points

Questions  What factors contribute to parent choice predisposition for treatment of pediatric obstructive sleep-disordered breathing (OSDB), and how is choice predisposition associated with parent–clinician communication?

Findings  In this cohort study including audiorecorded consultations of 52 parent–clinician dyads, non-Hispanic White parents and parents of patients who had been previously evaluated by a pediatrician for their OSDB were more predisposed to surgical treatment with tonsillectomy. Parents more predisposed to tonsillectomy demonstrated greater familiarity with OSDB but engaged less with clinicians during consultations.

Meaning  Understanding parent choice predisposition for surgical treatment with tonsillectomy may guide counseling by promoting clinician engagement of parents, identifying patient and external factors associated with surgical decisions, and sharing of information to improve knowledge about disease and treatment alternatives.


Importance  The decision to proceed with tonsillectomy to treat pediatric obstructive sleep-disordered breathing (OSDB) often falls on individual families. Despite emphasis on shared decision-making between parents and surgeons about tonsillectomy for OSDB, the extent to which parents have already decided about surgery prior to the child’s consultation is not known.

Objective  To identify predictors of parent choice predisposition for surgical treatment of OSDB with tonsillectomy and describe its association with parent–clinician communication.

Design, Setting, and Participants  Observational cohort study conducted at 3 outpatient clinical sites (urban-based outpatient center, suburban off-site outpatient center, and community-based medical center) associated with a large academic center. A total of 149 parents of children undergoing their initial otolaryngology consultation for OSDB were identified through clinic scheduling records and deemed eligible for participation in this study. Of the 149 parents, a volunteer sample of 64 parents (42.9%) agreed to participate and have their consultation audiorecorded. Of these 64 participants, 12 parents were excluded because their child had previously been evaluated for OSDB by a specialist.

Main Outcomes and Measures  The primary outcomes and measures were treatment choice predisposition scale (a measure of the strength of a patient’s treatment decision prior to entering a medical consultation), parent communication behaviors coded in consultation audiorecordings (substantive questions asked, introduced medical jargon, expression of treatment preference, and scores on the OSDB and Adenotonsillectomy Knowledge Scale for parents).

Results  A total of 52 parent participants were included in the final analysis. Most parent participants were female (n = 48; 92%); 50% (n = 26) of parents were non-Hispanic White, 37% (n = 19) were Black, 10% (n = 5) were Hispanic/Latino, and 4% (n = 2) self-reported race/ethnicity as “Other.” Mean (range) choice predisposition was 6.84 (2-10), with 22 parents (42%) more predisposed to choose tonsillectomy. Parents more predisposed to choose tonsillectomy used more medical jargon during the consultation (odds ratio [OR], 3.95; 95% CI, 1.16-15.15) and were less likely to ask questions (OR, 0.22; 95% CI, 0.05-0.87). Parental predictors of greater predisposition toward choosing surgery were White race (OR, 7.31; 95% CI, 1.77-39.33) and prior evaluation by a pediatrician for OSDB (OR, 6.10; 95% CI, 1.44-33.34).

Conclusions and Relevance  In this cohort study of parents of children with OSDB, many parents were predisposed to choose treatment with tonsillectomy prior to initial surgical consultation, which may lessen engagement and influence 2-way communication. In this cohort, greater predisposition for tonsillectomy was observed in non-Hispanic White parents and parents of patients who had been previously evaluated by a pediatrician for OSDB. Understanding parent choice predisposition for surgery may promote improved communication and parental engagement during surgical consultations. It may also help direct education about sleep and tonsillectomy to nonsurgical forums.

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