Medical decision-making among adolescents with neonatal brachial plexus palsy and their families: a qualitative study.


BACKGROUND:Elective surgical management of neonatal brachial plexus palsy is complex, variable, and often individualized. Little is known about the medical decision-making process among adolescents with neonatal brachial plexus palsy and their families when faced with making complex treatment decisions. The experiences of these patients and their parents were analyzed to identify key factors in the decision-making process. METHODS:Eighteen adolescents with residual neonatal brachial plexus palsy deficits between 10 and 17 years and their parents were included. Qualitative research design was used involving separate, 1-hour, in person, semistructured interviews, which were audio recorded and transcribed. Grounded theory was applied by two members of the research team to identify recurrent themes and create a codebook that was applied to the data. RESULTS:Medical decision-making among adolescents with neonatal brachial plexus palsy and their families is multifaceted and individualized, composed of both patient- and system-dependent factors. Four codes were identified: (1) knowledge acquisition, (2) multidisciplinary care, (3) adolescent autonomy, and (4) patient expectations and treatment desires. Overall, parental decision-making was heavily influenced by system-dependent factors, whereas adolescents largely based their decisions on individual treatment desires to improve function and/or aesthetics. CONCLUSIONS:There are many areas for improving the delivery of information and health care organization among adolescents with neonatal brachial plexus palsy and their families. The authors recommend the development of educational interdisciplinary programs and decision aids containing evidence-based management guidelines targeted toward primary care providers and patients. The authors believe that a computer-based learning module may provide the best avenue to achieve maximum penetrance and convenience of information sharing. CLINICAL QUESTION/LEVEL OF EVIDENCE:Therapeutic, IV.


Plast Reconstr Surg


Squitieri L,Larson BP,Chang KW,Yang LJ,Chung KC




Has Abstract


2013-06-01 00:00:00














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    abstract::This paper discusses a case of congenital leukemia cutis of lymphoblastic type presenting as a solitary frontonasal tumor. The presentation is unusual when compared with other reported cases of neonatal leukemia and represents the only reported case with comparable presenting features to the authors' knowledge. The di...

    journal_title:Plastic and reconstructive surgery

    pub_type: 杂志文章


    authors: Campbell DC,Grippaudo FR,Lewandowski R

    更新日期:1997-12-01 00:00:00

  • Pilomatrixoma presenting as a parotid mass.

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    journal_title:Plastic and reconstructive surgery

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  • The ideal nasolabial angle in rhinoplasty: a preference analysis of the general population.

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    authors: Sinno HH,Markarian MK,Ibrahim AMS,Lin SJ

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  • Improved malar projection with transconjunctival hydroxyapatite granules.

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  • A consecutive case review of orbital blowout fractures and recommendations for comprehensive management.

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  • Breast reconstruction using an inflatable breast implant with detachable reservoir.

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    journal_title:Plastic and reconstructive surgery

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  • The psychic consequences of a reduction mammaplasty.

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    journal_title:Plastic and reconstructive surgery

    pub_type: 杂志文章


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    journal_title:Plastic and reconstructive surgery

    pub_type: 杂志文章


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    journal_title:Plastic and reconstructive surgery

    pub_type: 杂志文章


    authors: Adams JR,Kawamoto HK

    更新日期:1995-02-01 00:00:00

  • Surgical management of penoscrotal lymphangioma circumscriptum.

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    journal_title:Plastic and reconstructive surgery

    pub_type: 杂志文章


    authors: Latifoğlu O,Yavuzer R,Demir Y,Ayhan S,Yenidünya S,Atabay K

    更新日期:1999-01-01 00:00:00

  • Prospective study of the accuracy of the surgeon's diagnosis in 2000 excised skin tumors.

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    journal_title:Plastic and reconstructive surgery

    pub_type: 杂志文章


    authors: Hallock GG,Lutz DA

    更新日期:1998-04-01 00:00:00

  • Use of the united suture in microvascular anastomoses.

    abstract::A technique for microvascular anastomoses is described. It leaves one suture united until the last, a maneuver which helps to avoid picking up the posterior wall with the anterior wall. ...

    journal_title:Plastic and reconstructive surgery

    pub_type: 杂志文章


    authors: Harashina T

    更新日期:1977-01-01 00:00:00