Analysis of decisional conflict among parents who consent to hypospadias repair: single institution prospective study of 100 couples.
OBJECTIVE
Although obtaining informed consent for distal hypospadias repair is common practice, little is known about the uncertainty or conflict between consenting parents faced with this decision. We systematically evaluated decisional conflict between parents who elected to have their child undergo hypospadias surgery.


METHODS
A total of 100 couples who were counseled about treatment options agreed to participate. Using a validated questionnaire, the Decisional Conflict Scale, we prospectively collected data on decisional conflict demographics, preference for circumcision, education level and prior knowledge about hypospadias.


RESULTS
All parents elected surgical repair. Evidence of decisional conflict was encountered in 28% of participants (score less than 25 in 72%, 25 to 37.5 in 23.5%, greater than 37.5 in 4.5%). No statistically significant differences among parents were noted for total score (mean ± SD 16.1 ± 12 in mothers and 18.3 ± 12.6 in fathers) or subscales, except the informed subscale (mean ± SD 16.7 ± 14.3 in mothers and 21.1 ± 16.6 in fathers). Parental self-report of prior knowledge about hypospadias and preference for neonatal circumcision correlated with lower Decisional Conflict Scale scores (p = 0.02 and p <0.01, respectively). No statistical association was found between score and parental education level (p = 0.7) or expertise of the counselor (staff vs pediatric urology fellow, p = 0.4).


CONCLUSIONS
These data describe the level of decisional conflict in couples agreeing to proceed with hypospadias repair, with no evidence of significant discrepancy between them. The novel description of factors related to decreased decisional conflict might help focus efforts aimed at minimizing difficulties encountered during the decision making process.
Division of Urology, Hospital for Sick Children and University of Toronto, Toronto, Ontario, Canada. armando.lorenzo@sickkids.ca
Armando J
AJ
Lorenzo
Luis H P
LH
Braga
Bozana
B
Zlateska
Bruno
B
Leslie
Walid A
WA
Farhat
Darius J
DJ
Bägli
Joao L
JL
Pippi Salle
D002675:Child, Preschool; D003220:Conflict, Psychological; D003657:Decision Making; D005260:Female; D006801:Humans; D007021:Hypospadias / Q000523:psychology* / Q000601:surgery*; D007223:Infant; D008297:Male; D033282:Parental Consent; D010290:Parents / Q000193:education / Q000523:psychology*; D011446:Prospective Studies; D012189:Retrospective Studies; D011795:Surveys and Questionnaires; D035501:Uncertainty