title: Shaping parents: impact of contrasting professional counseling on parents' decision making for children with disorders of sex development.
abstract: BACKGROUND
  The management of disorders or differences of sex development (DSD) remains complex, especially with respect to parents' decision for or against early genitoplasty. Most parents still tend to disfavor postponing surgery until the child is old enough to provide consent.
  
  
  OBJECTIVE
  To identify the determinants of parental decisions for or against early sex assignment surgery in DSD children, and in particular to assess the influence of contrasting behavior of health-care professionals and the information they dispense.
  
  
  METHODS
  Preliminary data analysis from a focus group identified two broad approaches to counseling information. Two six-minute counseling videos were produced on this basis: one medicalized, by an endocrinologist, the other demedicalized, by a psychologist. Third-year medical students (N = 89) were randomized to watch either video as prospective parents and report its impact on their decision in a self-administered questionnaire.
  
  
  METHODS
  Statistical analysis of questionnaire responses regarding decisions for or against surgery, including self-assessed impact of potential determinants.
  
  
  RESULTS
  Thirty-eight of eighty-nine "parents" (43%) chose early surgery for "their" child, including 27/41 "parents" (66%) shown the medicalized video vs. 11/48 (23%) shown the demedicalized video (P < 0.001). Desired aims for "their" child also differed significantly depending on the counseling approach viewed. Yet "parents" perceived their personal attitudes on a four-point Likert scale as the main influence on their decision although their "attitude" was significantly shaped by the video.
  
  
  CONCLUSIONS
  Parental decisions concerning early sex assignment surgery for DSD children depend on the health professional counseling received, to a degree of which neither parents nor professionals appear fully aware. In the absence of conclusive data for or against early surgery, there is a danger of medicalized or demedicalized parentalism resulting in irreversible and inadequately grounded decisions, regardless of the consensus statement of 2005 and the subsequent call for multidisciplinary management.
authors.affiliation: Institute of Biomedical Ethics, University of Zürich, Zürich, Switzerland. streuli@ethik.uzh.ch
authors.forename: Jürg C
authors.initials: JC
authors.lastname: Streuli
authors.forename: Effy
authors.initials: E
authors.lastname: Vayena
authors.forename: Yvonne
authors.initials: Y
authors.lastname: Cavicchia-Balmer
authors.forename: Johannes
authors.initials: J
authors.lastname: Huber
mesh_terms: D001290:Attitude; D002648:Child; D003376:Counseling; D003657:Decision Making; D012734:Disorders of Sex Development / Q000523:psychology*; D005260:Female; D017144:Focus Groups; D006801:Humans; D008297:Male; D010290:Parents; D010820:Physicians; D011446:Prospective Studies; D011795:Surveys and Questionnaires
keywords: Disorders of Sex Development; Informed Consent; Intersex; Normality; Pediatric Endocrinology; Pediatric Psychology