Inpatient versus outpatient management of low-risk pediatric febrile neutropenia: measuring parents' and healthcare professionals' preferences.
OBJECTIVE
Our primary objective was to describe and compare parents' and healthcare professionals' strength of preference scores for outpatient oral antibiotic relative to inpatient parenteral antibiotic treatment for low-risk febrile neutropenic children. Our secondary objective was to identify predictors of strength of preference for oral outpatient treatment.


METHODS
Respondents were parents of children receiving cancer chemotherapy, and pediatric oncology healthcare professionals. First, the inpatient and outpatient options were described, and the respondent indicated their initially preferred option. The respondent next ranked how important seven factors (including "fear/anxiety" and "comfort") were in making their initial choice. The threshold technique was then used to elicit the respondent's strength of preference score for oral outpatient, relative to parenteral inpatient management.


RESULTS
There were 75 parent and 42 healthcare-professional respondents. There was no significant difference (P =.08) in the proportions of parents (40 of 75; 53%) and healthcare professionals (30 of 42; 71%) who initially would choose outpatient management. For parents, stronger preference for oral outpatient therapy was associated with higher anticipated quality of life for the parent and child at home relative to hospital, lower importance rank for "fear/anxiety," and higher importance rank for "comfort." Conversely, for professionals, only lower importance rank for "fear/anxiety" was associated with higher strength of preference scores for outpatient oral antibiotic management.


CONCLUSIONS
Only 53% of parents would choose outpatient oral antibiotic management for low-risk febrile neutropenia. Predictors of strength of preference scores for outpatient oral antibiotic relative to inpatient parenteral antibiotic treatment differed between parent and professional respondents.
Department of Pediatrics, University of Toronto, Ontario, Canada. lillian.sung@sickkids.ca
Lillian
L
Sung
Brian M
BM
Feldman
Gina
G
Schwamborn
Diana
D
Paczesny
Ashley
A
Cochrane
Mark L
ML
Greenberg
Anne Marie
AM
Maloney
Eleanor I
EI
Hendershot
Ahmed
A
Naqvi
Maru
M
Barrera
Hilary A
HA
Llewellyn-Thomas
D000284:Administration, Oral; D000553:Ambulatory Care; D000900:Anti-Bacterial Agents / Q000008:administration & dosage*; D000970:Antineoplastic Agents / Q000009:adverse effects; D002648:Child; D002675:Child, Preschool; D005260:Female; D005334:Fever / Q000139:chemically induced / Q000188:drug therapy*; D006282:Health Personnel; D006760:Hospitalization; D006801:Humans; D007263:Infusions, Parenteral; D008297:Male; D009503:Neutropenia / Q000139:chemically induced / Q000188:drug therapy*; D010290:Parents
D000900:Anti-Bacterial Agents; D000970:Antineoplastic Agents