Exploring decision-making in paediatric surgery: A focus on the transition period and healthcare professionals' understanding of psychosocial and cultural factors in cleft orthognathic surgery.

Clegg, Holly Rose (2024) Exploring decision-making in paediatric surgery: A focus on the transition period and healthcare professionals' understanding of psychosocial and cultural factors in cleft orthognathic surgery. Doctoral thesis, University of East Anglia.

Preview

PDF Download (6MB) | Preview

Abstract

Objective: Previous research has explored the decision-making experiences of young people and their families in relation to orthognathic surgery (OS); however, less is known about how clinicians experience this process. Psychological, social, and cultural factors are highlighted when discussing young people’s experiences of living with and seeking treatment for a cleft lip and/or palate (CL/P), however the literature suggests that clinicians often do not receive training in this. The thesis portfolio aims to identify barriers and facilitators to engaging in shared decision-making (SDM) in acute paediatric surgery, whilst exploring how clinicians understand and consider psychosocial and cultural factors, when supporting young people with CL/P in their decision-making for OS.

Design: A systematic review was conducted which explored the perceived barriers and facilitators to engaging in SDM in acute paediatric surgery. In supplement, a qualitative study was conducted with nine clinicians working in CL/P services which explored clinician awareness and consideration of psychosocial and cultural factors, and ethical dilemmas arising during SDM.

Results: The review revealed four key themes; understanding the patients’ information needs, engaging in effective communication, promoting access to support and involving the patients support network. In focussing on OS, themes centred around the SDM environment, balancing patient autonomy and beneficence, and fostering opportunities for team liaison. Health inequalities were also highlighted, relating to socioeconomic status, financial and educational/employment considerations.

Conclusions: A complex interplay of factors were found to influence the decision-making process. Further research may wish to evaluate the effectiveness of SDM interventions, when supporting young people and their families. When focussing on OS, the gravity of making a decision is acknowledged whereby it is important to optimise the SDM environment and create opportunities for liaison. It is recommended that further research focus on exploring and addressing health inequalities.

Item Type:	Thesis (Doctoral)
Faculty \ School:	Faculty of Medicine and Health Sciences > Norwich Medical School
Depositing User:	Nicola Veasy
Date Deposited:	07 Nov 2024 10:16
Last Modified:	07 Nov 2024 10:16
URI:	https://ueaeprints.uea.ac.uk/id/eprint/97555
DOI:

Downloads

Actions (login required)

View Item