Paul L Aronson1,2, Paula Schaeffer3, Liana Fraenkel4,5, Eugene D Shapiro3,6, Linda M Niccolai6. 1. Departments of Pediatrics paul.aronson@yale.edu. 2. Emergency Medicine, and. 3. Departments of Pediatrics. 4. Internal Medicine, Yale School of Medicine and. 5. VA Connecticut Healthcare System, West Haven, Connecticut. 6. Department of Epidemiology of Microbial Diseases, Yale School of Public Health, Yale University, New Haven, Connecticut; and.
Abstract
OBJECTIVES: There is wide variation in the decision of whether to perform lumbar punctures (LPs) on well-appearing febrile infants ≤8 weeks old. Our objectives were to identify factors that influence that decision and the barriers and facilitators to shared decision-making about LP with parents of febrile infants. METHODS: We conducted semistructured interviews with 15 pediatric and general emergency medicine physicians and 8 pediatric emergency medicine nurses at an urban, academic medical center. Through interviews, we assessed physicians' practices and physicians' and nurses' perspectives about communication and decision-making with parents of febrile infants. Two researchers independently reviewed the transcripts, coded the data using the constant comparative method, and identified themes. RESULTS: Five themes emerged for factors that influence physicians' decisions about whether to perform an LP: (1) the age of the infant; (2) the physician's clinical experience; (3) the physician's use of research findings; (4) the physician's values, particularly risk aversion; and (5) the role of the primary care pediatrician. Barriers and facilitators to shared decision-making identified by physicians and by nurses included factors related to their perceptions of parents' understanding and acceptance of risks, parents' emotions, physicians' assessment of whether there is clinical equipoise, and availability of follow-up with the primary care pediatrician. CONCLUSIONS: Differences in physicians' values, use of research findings, and clinical experience likely contribute to decisions of whether to perform an LP on well-appearing febrile infants. Incorporation of parents' preferences through shared decision-making may be indicated, although there are barriers that would need to be overcome.
OBJECTIVES: There is wide variation in the decision of whether to perform lumbar punctures (LPs) on well-appearing febrile infants ≤8 weeks old. Our objectives were to identify factors that influence that decision and the barriers and facilitators to shared decision-making about LP with parents of febrile infants. METHODS: We conducted semistructured interviews with 15 pediatric and general emergency medicine physicians and 8 pediatric emergency medicine nurses at an urban, academic medical center. Through interviews, we assessed physicians' practices and physicians' and nurses' perspectives about communication and decision-making with parents of febrile infants. Two researchers independently reviewed the transcripts, coded the data using the constant comparative method, and identified themes. RESULTS: Five themes emerged for factors that influence physicians' decisions about whether to perform an LP: (1) the age of the infant; (2) the physician's clinical experience; (3) the physician's use of research findings; (4) the physician's values, particularly risk aversion; and (5) the role of the primary care pediatrician. Barriers and facilitators to shared decision-making identified by physicians and by nurses included factors related to their perceptions of parents' understanding and acceptance of risks, parents' emotions, physicians' assessment of whether there is clinical equipoise, and availability of follow-up with the primary care pediatrician. CONCLUSIONS: Differences in physicians' values, use of research findings, and clinical experience likely contribute to decisions of whether to perform an LP on well-appearing febrile infants. Incorporation of parents' preferences through shared decision-making may be indicated, although there are barriers that would need to be overcome.
Authors: Paul L Aronson; Cary Thurm; Elizabeth R Alpern; Evaline A Alessandrini; Derek J Williams; Samir S Shah; Lise E Nigrovic; Russell J McCulloh; Amanda Schondelmeyer; Joel S Tieder; Mark I Neuman Journal: Pediatrics Date: 2014-10 Impact factor: 7.124
Authors: Paul L Aronson; Cary Thurm; Derek J Williams; Lise E Nigrovic; Elizabeth R Alpern; Joel S Tieder; Samir S Shah; Russell J McCulloh; Fran Balamuth; Amanda C Schondelmeyer; Evaline A Alessandrini; Whitney L Browning; Angela L Myers; Mark I Neuman Journal: J Hosp Med Date: 2015-02-13 Impact factor: 2.960
Authors: Paul L Aronson; Marie E Wang; Eugene D Shapiro; Samir S Shah; Adrienne G DePorre; Russell J McCulloh; Christopher M Pruitt; Sanyukta Desai; Lise E Nigrovic; Richard D Marble; Rianna C Leazer; Sahar N Rooholamini; Laura F Sartori; Fran Balamuth; Christopher Woll; Mark I Neuman Journal: Pediatrics Date: 2018-11-13 Impact factor: 7.124
Authors: Nathan Kuppermann; Peter S Dayan; Deborah A Levine; Melissa Vitale; Leah Tzimenatos; Michael G Tunik; Mary Saunders; Richard M Ruddy; Genie Roosevelt; Alexander J Rogers; Elizabeth C Powell; Lise E Nigrovic; Jared Muenzer; James G Linakis; Kathleen Grisanti; David M Jaffe; John D Hoyle; Richard Greenberg; Rajender Gattu; Andrea T Cruz; Ellen F Crain; Daniel M Cohen; Anne Brayer; Dominic Borgialli; Bema Bonsu; Lorin Browne; Stephen Blumberg; Jonathan E Bennett; Shireen M Atabaki; Jennifer Anders; Elizabeth R Alpern; Benjamin Miller; T Charles Casper; J Michael Dean; Octavio Ramilo; Prashant Mahajan Journal: JAMA Pediatr Date: 2019-04-01 Impact factor: 16.193
Authors: Elizabeth C Powell; Prashant V Mahajan; Genie Roosevelt; John D Hoyle; Rajender Gattu; Andrea T Cruz; Alexander J Rogers; Shireen M Atabaki; David M Jaffe; T Charles Casper; Octavio Ramilo; Nathan Kuppermann Journal: Ann Emerg Med Date: 2017-10-06 Impact factor: 5.721
Authors: Glyn Elwyn; Dominick Frosch; Richard Thomson; Natalie Joseph-Williams; Amy Lloyd; Paul Kinnersley; Emma Cording; Dave Tomson; Carole Dodd; Stephen Rollnick; Adrian Edwards; Michael Barry Journal: J Gen Intern Med Date: 2012-05-23 Impact factor: 5.128
Authors: Paul L Aronson; Eduardo Fleischer; Paula Schaeffer; Liana Fraenkel; Mary C Politi; Marney A White Journal: Pediatr Emerg Care Date: 2022-02-01 Impact factor: 1.454
Authors: Patrick J Van Winkle; Samantha N Lee; Qiaoling Chen; Aileen S Baecker; Dustin W Ballard; David R Vinson; Tara L Greenhow; Tran H P Nguyen; Beverly R Young; Amy L Alabaster; Jie Huang; Stacy Park; Adam L Sharp Journal: J Am Coll Emerg Physicians Open Date: 2022-06-17
Authors: Colleen K Gutman; K Casey Lion; Paul Aronson; Carla Fisher; Carma Bylund; Antionette McFarlane; Xiangyang Lou; Mary D Patterson; Ahmed Lababidi; Rosemarie Fernandez Journal: BMJ Open Date: 2022-09-20 Impact factor: 3.006
Authors: Paul L Aronson; Paula Schaeffer; Linda M Niccolai; Eugene D Shapiro; Liana Fraenkel Journal: Pediatr Emerg Care Date: 2021-12-01 Impact factor: 1.454
Authors: Paul L Aronson; Mary C Politi; Paula Schaeffer; Eduardo Fleischer; Eugene D Shapiro; Linda M Niccolai; Elizabeth R Alpern; Steven L Bernstein; Liana Fraenkel Journal: Acad Emerg Med Date: 2020-09-09 Impact factor: 3.451