Parental preferences in treatment of acute uncomplicated appendicitis comparing surgery to conservative management with antibiotics and their views on research participation

• Published in: European journal of pediatrics 2020-05, Vol.179 (5), p.735-742
• Main Authors: Kyaw, Lin, Pereira, Natalie Kate, Ang, Chen Xiang, Choo, Candy S. C., Nah, Shireen Anne
• Format: Article
• Language: English
• Subjects: Adolescent; Adult; Anti-Bacterial Agents - therapeutic use; Antibiotics; Appendectomy - psychology; Appendectomy - statistics & numerical data; Appendicitis; Appendicitis - therapy; Attitude to Health; Child; Child, Preschool; Children; Clinical trials; Conservative Treatment - methods; Conservative Treatment - psychology; Conservative Treatment - statistics & numerical data; Disease management; Fear; Female; Humans; Male; Medicine; Medicine & Public Health; Middle Aged; Original Article; Parents & parenting; Parents - psychology; Patient Preference - psychology; Patients; Pediatrics; Pilot Projects; Preferences; Randomized Controlled Trials as Topic - psychology; Surgery; Surveys and Questionnaires
• ISSN: 0340-6199; 1432-1076
• DOI: 10.1007/s00431-019-03555-w

Studies show that conservative management in acute uncomplicated appendicitis (AUA) is an alternative to surgery. This study aims to determine factors affecting parental preference in management of AUA and their decision for research participation. We conducted surveys on parents whose children were admitted with suspicion of appendicitis but later confirmed not to have appendicitis. Information on appendicectomy versus conservative treatment with antibiotics was provided using a fixed script and standard information leaflet. Questionnaires covered factors influencing decisions, opinions regarding research, treatment preference and demographic data. We excluded parents not fluent in English. Of 113 respondents, 71(62.8%) chose antibiotics, 39(34.5%) chose appendicectomy, and 3(2.7%) had no preference. Reasons given for choosing antibiotics were fear of surgical risks and preferring less invasive treatment. Those choosing appendicectomy expressed preference for definitive treatment and fear of recurrence. Majority were against randomisation ( n  = 89, 78.8%) and blinding ( n  = 90, 79.7%). Over half found difficulty involving their child in research ( n  = 65, 57.5%). Most thought that research is important (66.4%) and beneficial to others (59.3%). Parents who perceived their child as healthy found research riskier ( p  = 0.039). Educated parents were more likely to find research beneficial to others ( p  = 0.012) but less accepting of randomisation ( p  = 0.001). Conclusion : More parents appear to prefer conservative treatment for acute uncomplicated appendicitis. Researchers must consider parental concerns regarding randomisation and blinding. What is Known: • Conservative management of acute uncomplicated appendicitis in paediatric patients is safe and effective, sparing the child the need for an operation; however, neither conservative nor surgical management is proven to be superior. • Randomised controlled trials provide the highest level of evidence, but it is challenging to recruit paediatric patients as participants in such clinical trials . What is New: • More parents prefer conservative management of uncomplicated appendicitis over surgical management for their children due to fear of surgical risks and complications • Randomisation in trial design is significantly associated with a parent’s decision to reject their child’s participation in a clinical trial.