Are parents of children hospitalized with severe community‐acquired pneumonia more satisfied with care when physicians allow them to share decisions on the antibiotic route?

• Published in: Health expectations : an international journal of public participation in health care and health policy Vol. 18; no. 6; pp. 2278 - 2287
• Main Authors: Rosati, Paola, Di Salvo, Viviana, Crudo, Stefania, D'Amico, Roberto, Carlino, Cecilia, Marchili, Maria Rosaria, Gonfiantini, Michaela, Di Ciommo, Vincenzo
• Format: Journal Article
• Language: English
• Published: England John Wiley & Sons, Inc 01-12-2015; John Wiley and Sons Inc
• Subjects: Age; Amoxicillin; Anonymity; Anti-Bacterial Agents - therapeutic use; Antibiotics; Assignment; Asthma; Child, Preschool; Children; Children & youth; Clinical decision making; Clinical information; Clinical medicine; Community-Acquired Infections - drug therapy; community‐acquired infections; Consumer Behavior; Decision Making; Drug Administration Routes; Efficacy; evidence‐based medicine; Female; Hospitalization; Hospitals; Humans; Infant; Male; Medical personnel; Original; Original Research Papers; Pain; Parental satisfaction; Parents; Parents & parenting; Parents - psychology; patient participation; Pediatricians; Physicians; Pneumonia; Pneumonia - drug therapy; preference‐sensitive decisions; Questionnaires; Severity; shared‐decision making; Surveys and Questionnaires; United States > US; preference-sensitive decisions; community-acquired infections; shared-decision making; pneumonia; patient participation; evidence-based medicine
• ISSN: 1369-6513; 1369-7625
• DOI: 10.1111/hex.12197

Context and objective
Despite convincing evidence that oral and injected amoxicillin have equal efficacy in children with severe community‐acquired pneumonia (CAP), hospitalized children often receive injected antibiotics. To investigate whether shared decision‐making (choosing the antibiotic route) influences parental satisfaction.
Design, setting and participants
In a one‐year questionnaire‐based study, we enrolled consecutive children hospitalized for CAP. At admission, all children's parents received a leaflet on CAP. Parents arriving during the daytime were assigned to a shared group and could choose the antibiotic route, those admitted at other times were assigned to an unshared group for whom physicians chose the antibiotic route. Shared group parents answered anonymous questionnaire investigating why they chose a specific route. Parents in both groups answered another anonymous questionnaire at discharge assessing perceived satisfaction with care.
Main outcome measure
Parents' satisfaction with perceived medical information as assessed by data from a questionnaire.
Results
Of the 95 children enrolled, more children's parents were assigned to the unshared than the shared group (77 vs. 18). Of the 18 children's parents in the shared group, 14 chose the oral antibiotic route mainly to avoid painful injections. Doctors explanations were considered better in the shared than in the unshared group (P = 0.02).
Discussion and conclusions
The larger number of children's parents assigned to the unshared group reflects paediatricians' reluctance to offer shared‐decision making. Well‐informed parents prefer oral antibiotic therapy for children with severe CAP. Allowing parents choose the antibiotic route respects parents' wishes, reduces children's pain and improves satisfaction.