Many factors influence parental decisions about throat surgery

Better communication from doctors may help parents struggling with the decision to have their child undergo throat surgery for sleep disordered-breathing conditions, a small study suggests.

About 20 percent of children have issues with breathing while asleep, such as snoring and sleep apnea, and surgical removal of the tonsils and adenoids in an adenotonsillectomy is the primary treatment. But rates of the surgery vary widely across the U.S., raising concerns that it may be overused in some populations and underused in others, the authors write in JAMA Otolaryngology, Head and Neck Surgery.

"We don't necessarily know that there is overuse, but there is variation we can't explain based on clinical and demographic factors," said lead author Dr. Emily F. Boss of Johns Hopkins University School of Medicine in Baltimore. "We can't explain it based on patient differences alone, so we tried to elicit from parents their preferences."

The researchers interviewed 11 parents of children aged 2 to 17 years who had been evaluated for sleep disordered breathing. Boss's team asked parents about their experiences leading up to the evaluation, their communication with doctors and their experiences with deciding whether to choose surgery.

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Four children had been treated by being put on allergy medication, nine had undergone sleep studies, two had adenoid removal surgery and six had adenotonsillectomy.

Overall, parents said the severity of their child's sleep disordered breathing and the risks and benefits of the surgery were important factors in their decisions about treatment, as were their interactions with doctors.

Parents were often afraid that snoring or sleep apnea would cause the child to stop breathing in the night, or to have brain development delays, which led them to feel the need for treatment was "urgent." Some considered surgery a "last resort," though, and were more concerned about the risks of anesthesia than of surgery itself.

Interpersonal factors like parents' impressions when the doctor engaged their child in conversation, diagrammed sleep disordered breathing visually and were accessible for questions were all important, the researchers found.

"Another thing we learned is parents are focusing on the risks of general anesthesia, and not emphasizing this to the surgeon," Boss told Reuters Health.

In reality, anesthesia carries far less risk than surgery itself, she said.

"We as surgeons need to present balanced information," she said.

"There has been an enormous shift toward better communication with patients/families so that the decision to do an operation (in this case adenotonsillectomy) is made after making a thorough assessment of the clinical condition, the individual's personal situation, discussing the clinical condition, its current and potential consequences and treatment options," said Dr. Patrick Dawes of the Dunedin School of Medicine at the University of Otago in New Zealand, who was not part of the new study.

"This can be quite time consuming and will include weighing up the likelihood of different treatments being effective, the chance of a successful outcome, the recovery after surgery, post-surgery management and complications that may occur," Dawes told Reuters Health by email.

Doctors should pay attention to the reported parent concerns and try to ensure these are addressed within the consultation and aim to provide what parents value when reaching a decision about their child's treatment, he added.