Evidence map›Paper›PMID 35641980›Full record

ArticleJournal of cardiothoracic surgery2022

The involvement and autonomy of young children undergoing elective paediatric cardiac surgery: a qualitative study.

Priscilla Alderson, Marc Cohen, Ben Davies, Martin J Elliott, Mae Johnson, Alessandra Lotteria, Rosa Mendizabal, Emma Stockton, Michael Stylianou, Katy Sutcliffe and 1 more

Open access · goldAbstract read
PubMed Full text at PMC Publisher
In one paragraph

Article in Journal of cardiothoracic surgery, 2022. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 2 papers.

0numbers the graph read from it
0cells of the map it votes in
2citing papers in PubMed
2.3field-weighted citation impact, top 12% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

2 citing papers in PubMed, 6 citations in OpenAlex.

  1. Article
  2. Article
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

11 authors at 4 institutions in 2 countries.

Priscilla AldersonSocial Research Institute, University College London, 18 Woburn Square, London, WC1H 0NR, UK. p.alderson@ucl.ac.uk.ORCID http://orcid.org/0000-0003-4002-4501
Marc CohenGreat Ormond Street Hospital for Children NHS Trust, London, UK.
Ben DaviesRoyal Children's Hospital, Melbourne, Australia.
Martin J ElliottCardiothoracic Surgery, University College London, London, UK.
Mae JohnsonGreat Ormond Street Hospital for Children NHS Trust, London, UK.
Alessandra LotteriaEvelina Children's Hospital, Guy's and St Thomas's NHS Trust, London, UK.
Rosa MendizabalSocial Research Institute, University College London, 18 Woburn Square, London, WC1H 0NR, UK.
Emma StocktonGreat Ormond Street Hospital for Children NHS Trust, London, UK.
Michael StylianouGreat Ormond Street Hospital for Children NHS Trust, London, UK.
Katy SutcliffeSocial Research Institute, University College London, 18 Woburn Square, London, WC1H 0NR, UK.
Hugo WellesleyGreat Ormond Street Hospital for Children NHS Trust, London, UK.
Great Ormond Street Hospital · GBUniversity College London · GBEnergy Institute · GBRoyal Children's Hospital · AU

Funding

British Heart Foundation UK project code: 546781/award number: 176835.
6 · The paper itself

Abstract

backgroundStandards generally reported in the literature about informing children and respecting their consent or refusal before elective heart surgery may differ from actual practice. This research aims to summarize the main themes in the literature about paediatric anaesthesia and compare these with research findings on how health professionals counsel young children before elective heart surgery, respect their consent or refusal, and maintain patient-centred care.

methodsThis qualitative research involved: literature reviews about children's consent to surgery and major interventions; observations of wards, clinics and medical meetings in two paediatric cardiology departments, October 2019 to February 2020; audio-recorded semi-structured interviews with 45 hospital staff, including 5 anaesthetists, and related experts, November 2019 to April 2021; interviews with 16 families, with children aged 6- to 15-years and their parents shortly after elective heart surgery, and some months later (reported in other papers); thematic data analysis; and research reports on how different professions contribute to children's informed decisions for heart surgery.

resultsThe medical, ethics and English legal literature tend to assume legal minors cannot refuse major recommended treatment, and cannot consent until they are 12 years or older. Little is said about informing pre-competent children. If children resist, some anaesthetists rely on sedation and distraction, and avoid much informed discussion, aiming to reduce peri-operative anxiety. However, interviewees reported informing young children, and respecting their consent or refusal before elective surgery. They may delay elective surgery and provide further information and support, aiming to reduce fear and promote trust. Six years of age was commonly cited as the threshold for respecting consent to heart transplantation.

conclusionDiffering views about younger children's competence, anxiety and best interests support different reactions to children's consent and refusal before elective heart surgery. This paper reports the zero-restraint policy followed for over a decade in at least one leading surgery centre. The related law and literature need to be updated, to take more account of evidence of actual practice.

Indexed as

Cardiac Surgical ProceduresInformed ConsentChildChild, PreschoolElective Surgical ProceduresHumansParentsQualitative ResearchCardiac surgeryConsentEthicsPaediatricsQualitative research

Identifiers

PMID35641980
PMCPMC9153234
OpenAlexW4281671740

What OpenQuestion holds

Textmetadata
LicenceCC BY
Read underepoch 390

Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.