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Parental Perspectives on Pre-Operative Counseling Regarding Pediatric General Anesthesia Exposure
Patrick Meade, BA, Yvonne Y. Chan, MD, Ilina Rosoklija, MPH, Hubert A. Benzon, MD, MPH, Eric C. Cheon, MD, David I. Chu, MD, MSCE.
Ann and Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, USA.

BACKGROUND:
In pediatric urology, surgical interventions are often performed under general anesthesia (GA) for several conditions at a young age. Preoperative counseling regarding GA exposure in children can be variable, and data on how parents prefer to receive this information are lacking. In this study, we surveyed parents of children who had undergone GA to determine which preoperative sources of information regarding GA they found to be most helpful. We hypothesized that parents would find their anesthesiologist to be the most helpful and that preference for anesthesiologists would be associated with higher parental health literacy.
METHODS:
We surveyed United States-based parents of children who had undergone GA prior to 6 years of age using Amazon Mechanical Turk, a crowdsourcing tool. Incoherent/invalid responses were excluded. Parents were asked to rank the following sources of information on GA exposure they found to be most helpful when their child underwent GA: surgeon, anesthesiologist, nursing staff, friends/family, the internet, social media, or other sources. Parental demographics and information regarding the child's GA exposure were also collected. Respondents were asked to rate their comfort with GA, concern over GA's potential effects on neurodevelopment, and their own health literacy on a 5 point Likert scale. Multivariable logistic regression models incorporating significant univariable analysis covariates compared parents who responded with either surgeon or anesthesiologist as their first choice.
RESULTS:
Of 607 parents surveyed, 532 (88%) ranked either the surgeon or anesthesiologist as the most helpful source of information, and of those, 352/532 (66%) identified the anesthesiologist as the top choice for pre-operative GA counseling. Among the 532 patients, 78% were white, 73% married, and 50% had a high self-reported health literacy. 44% of the children were under 2 years of age at the time of their GA exposure. On multivariable analysis, lower self-reported parental health literacy, but neither parental education nor child age at GA exposure, was significantly associated with ranking the surgeon over the anesthesiologist (p-trend=0.02; Table 1). Parental preference for source of GA information was not associated with either comfort with GA or concern with GA's potential neurodevelopmental effects.


CONCLUSIONS:
Although most parents chose anesthesiologists as the most helpful source of information regarding GA, a third still listed surgeons as the most helpful source. Parents with lower self-reported health literacy were more likely to rank surgeons first. This suggests that a significant proportion of parents favor some type of counseling regarding GA from their surgeon. Surgeons may need to be prepared to offer parents information on GA or provide opportunities for more in-depth counseling with anesthesiologists prior to day of surgery. Further qualitative studies will help us better understand the most effective method of information delivery.


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