Parental Opinions on Medical Decision-Making in Adolescence: A Case-Based Survey.

OBJECTIVE: Patient trust and consent are complex topics for health care workers in pediatrics, specifically when relating to adolescent's legal status. In the context of medical decisions, not much work has been performed to understand the opinion of parents on health care decision-making, especially on confidentiality concerning their adolescent children. The purpose of this research was to assess the parental opinions on these decisions and the influence of different perspectives. METHODS: We used a case-based methodology to assess parental opinions on fictional medical decisions. A survey was provided to parents in 2 pediatric outpatient departments in Belgium and the Netherlands. The survey contained cases regarding medical care related to confidentiality and consent about which participants gave their opinion. RESULTS: In total, 222 surveys were completed. Overall, most parents would allow an adolescent to make his/her own decision (58.6%-70.4%), except in the case of confidentiality on alcohol-related trauma (28.9%). The results show a significant difference in how parents responded when answering from the parental perspective or adolescents' perspective. They granted significantly more authority to the adolescent in the latter view. CONCLUSION: Our study shows that parents who were confronted with cases from an adolescent perspective were significantly more likely to give the patient authority. In addition, the medical issue and context influence how the parents responded. These data provide insight into the parental opinions and could lead to more evidence-based frameworks for shared medical decision-making of adolescents and their parents.

Neonatal respiratory mechanics and development of bronchial hyperresponsiveness in preterm infants.

BACKGROUND: In preterm ventilated infants, irreversible damage to the airway mucosa in the neonatal period might be related to the development of bronchial hyperresponsiveness (BHR) in subsequent years. AIMS: To evaluate whether neonatal indicators of long-term respiratory morbidity, respiratory system compliance (Crs) and resistance (Rrs), were causally related to bronchial responsiveness at the age of 2 and whether these relationships were affected by other factors. STUDY DESIGN: Mean neonatal Crs and Rrs of the first 3 days of life were assessed using the single breath occlusion technique. Bronchial challenge tests were performed at 2 years of age. When wheezing occurred during chest auscultation or oxygen saturation decreased below 90%, the provocative concentration of methacholine was recorded. SUBJECTS: Forty-five preterm infants of <37 weeks gestation, being mechanically ventilated within 24 h after birth. RESULTS: Decreased neonatal Crs was related to BHR (beta per ml/kPa, 0.061; 95% confidence interval, 0.019 to 0.103; p=0.006). Correction was required for radiological gradation of respiratory distress syndrome, the maximal peak inspiratory pressure required during mechanical ventilation and postnatal corticosteroid therapy. Neonatal Rrs, gestational age and birth weight were not related to subsequent BHR development. CONCLUSION: In ventilated preterm infants, decreased neonatal Crs was related to the development of BHR at the age of 2.