Exploring communication preferences and risk thresholds of clinicians and parents of febrile infants under 90 days presenting to the emergency department: a qualitative study

Kathryn Wilson*, Etimbuk Umana, David McCleary, Thomas Waterfield, Kerry Woolfall

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

1 Citation (Scopus)
14 Downloads (Pure)

Abstract

Background Febrile infants under 3 months of age are at higher risk of invasive bacterial illness (IBI) when compared with older children. Increasingly sequential assessment based on age, clinical appearance and biomarkers is used to determine the risk of IBI, and appropriateness of invasive procedures such as lumbar puncture. The purpose of this qualitative study is to report parents and clinicians’ opinions on communication of risks and benefits of sequential assessment and tailored treatment.

Methods 18 parents enrolled in the Febrile Infant Diagnostic Assessment and Outcomes study and seven clinicians from England, Wales and Northern Ireland were purposively selected to participate in virtual qualitative interviews. Data were analysed thematically.

Results Tailored treatment plans were widely supported. Confidence in the clinician was central to parents’ attitude towards management recommendations. Parents’ decision-making preferences change throughout their child’s clinical journey, with an initial preference for clinician-led decisions evolving towards collaborative decision-making as their stress and anxiety reduce. There were widespread differences in preferences for how risk was discussed. Parents self-reported poor retention of information and felt communication adjuncts helped their understanding. Clinicians were generally positive about the use of clinical decision aids as a communication tool, rather than relying on them for decision-making.

Discussion Parents want to feel informed, but their desire to be involved in shared decision-making evolves over time.

Clinicians appear to use their clinical judgement to provide individualised information, evolving their communication in response to perceived parental needs.

Poor information retention highlights the need for repetition of information and use of communication adjuncts.

Trial registration number NCT05259683.

Original languageEnglish
Pages (from-to)886-893
Number of pages8
JournalArchives of Disease in Childhood
Volume109
Issue number11
Early online date10 Jul 2024
DOIs
Publication statusPublished - 18 Oct 2024

Keywords

  • Emergency Care
  • Health services research
  • Paediatric Emergency Medicine
  • Qualitative research
  • Sepsis

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