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?
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.


METHODS
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.


METHODS
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).


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.
Unit of Clinical Epidemiology Bambino Gesù Children's Hospital IRCCS, Rome, Italy.
Paola
P
Rosati
Bambino Gesù Children's Hospital IRCCS, Rome, Italy.
Viviana
V
Di Salvo
Bambino Gesù Children's Hospital IRCCS, Rome, Italy.
Stefania
S
Crudo
Italian Cochrane Centre, Department of Diagnostic, Clinical and Public Health Medicine, University of Modena and Reggio Emilia, Modena, Italy.
Roberto
R
D'Amico
Reasearch Training Program, Facoltà di Medicina e Chirurgia, Università La Sapienza, Rome, Italy.
Cecilia
C
Carlino
Department of Paediatrics, Bambino Gesù Children's Hospital IRCCS, Rome, Italy.
Maria Rosaria
MR
Marchili
Department of Paediatrics, Bambino Gesù Children's Hospital IRCCS, Rome, Italy.
Michaela
M
Gonfiantini
Unit of Clinical Epidemiology Bambino Gesù Children's Hospital IRCCS, Rome, Italy.
Vincenzo
V
Di Ciommo
D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D002675:Child, Preschool; D017714:Community-Acquired Infections / Q000188:drug therapy*; D003258:Consumer Behavior; D003657:Decision Making; D004333:Drug Administration Routes; D005260:Female; D006801:Humans; D007223:Infant; D008297:Male; D010290:Parents / Q000523:psychology*; D010820:Physicians; D011014:Pneumonia / Q000188:drug therapy*; D011795:Surveys and Questionnaires
D000900:Anti-Bacterial Agents
community-acquired infections; evidence-based medicine; patient participation; pneumonia; preference-sensitive decisions; shared-decision making