VUR: What goes into parents’ treatment choices

Researchers developing a standardized shared decision-making tool for use by urologists and parents of children with vesicoureteral reflux (VUR) expect that it will be helpful for improving the quality of the provider-family discussion on VUR management options and ultimately parental satisfaction with care.  

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The purpose of the tool is to enable parents and physicians to identify issues that are most important to the family when deciding on treatment. It would thereby allow a more robust and thoughtful conversation regarding treatment options that is framed around a particular family’s prioritization of risks and benefits.

At the AUA annual meeting in San Diego, the authors presented the findings from completion of the first phase of the project that entailed detailed content analysis of semi-structured parental qualitative interviews to identify core themes describing parental preferences.

“Management options for children with VUR include watchful waiting, antibiotic prophylaxis, and surgery. However, these choices may offer a similar risk-benefit balance, and so there is often no one right answer for a given child, but there may be a best answer that accounts for the family’s values and preferences. To date, however, there are no clinical tools that can assist parents in formulating an evidence-based decision while simultaneously taking their preferences into account,” said senior author Hillary L. Copp, MD, MS, of the University of California, San Francisco.

“Such a decision-making tool is only as good as the foundation on which it is built. We are confident that we have now identified the different attributes of decision-making that are important to parents of children with VUR and have a solid base for creating the decision-making tool.”

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To identify core themes describing issues important to parents of children with VUR, Dr. Copp conducted semi-structured, qualitative interviews with parents of children who had been managed with the various treatment options. She continued to conduct interviews until no new ideas or concepts emerged. Then, transcripts of the interviews were reviewed and statements specifically differentiating between treatment options were extracted and grouped into themes by two independent researchers.

Next: 13 major themes identified

Through that process, 13 major themes were identified, Dr. Copp said. The most frequently cited related to the ability of the option to prevent future urinary tract infections (85%). Other dominant themes related to each treatment option’s unique efficacy rate (85%), compliance burdens (77%), risk of antibiotic resistance (69%), risk of chronic kidney damage (62%), providing the feeling of taking action (62%), invasiveness (58%), and anesthesia requirement (50%).

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After building the decision tool, the authors will evaluate it in the clinic to determine when and how it is best used. In addition, they are planning to conduct clinical trials in which parents might be randomly assigned to receive standard information about VUR management options alone or with use of the decision-making tool in order to assess if the tool affects issues such as decisional quality, conflict, and regret.

“Our hypothesis is that using the tool to allow more informed decision-making will lead to improvement in overall decision quality and also parental satisfaction with care,” Dr. Copp told Urology Times.

Dr. Copp’s collaborators in this project include Christopher Saigal, MD, MPH, University of California Los Angeles, who developed a shared decision-making tool for men with prostate cancer; Anand Bodapati, PhD, MS, of Anderson School of Management, University of California Los Angeles, who has expertise in conjoint analysis for marketing science; Jonathan C. Routh, MD, MPH, of Duke University; and Geraldine Tran, of the University of California, San Francisco.

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