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Timmermans S , Yang A , Gardner M , Keegan CE , Yashar BM , Fechner PY , Shnorhavorian M , Vilain E , Siminoff LA , Sandberg DE
Does Patient-centered Care Change Genital Surgery Decisions? The Strategic Use of Clinical Uncertainty in Disorders of Sex Development Clinics
J Health Soc Behav. 2018 Dec;59(4) :520-535
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Genital surgery in children with ambiguous or atypical genitalia has been marred by controversies about the appropriateness and timing of surgery, generating clinical uncertainty about decision making. Since 2006, medical experts and patient advocates have argued for putting the child's needs central as patient-centered care. Based on audio recordings of 31 parent-clinician interactions in three clinics of disorders of sex development, we analyze how parents and clinicians decide on genital surgery. We find that clinicians and parents aim for parent-centered rather than infant-centered care. Parents receive ambivalent messages about surgery: while clinicians express caution, they also present the surgery as beneficial. We examine how parents and clinicians reach agreement about surgery-differentiating parents who push strongly for surgery from parents who do not express any preconceived preferences about surgery and parents who resist surgery. We conclude that clinicians use clinical uncertainty about surgery strategically to direct parents toward perceived clinically appropriate decisions.
2150-6000 Timmermans, Stefan Yang, Ashelee Gardner, Melissa Keegan, Catherine E Yashar, Beverly M Fechner, Patricia Y Shnorhavorian, Margarett Vilain, Eric Siminoff, Laura A Sandberg, David E Journal Article United States J Health Soc Behav. 2018 Dec;59(4):520-535. doi: 10.1177/0022146518802460. Epub 2018 Oct 10.