Parent and Clinician Perspectives on Diagnostic Testing for Children With Diarrhea: A Qualitative Study.

Importance: Advances in diagnostics have enabled the detection of more gastrointestinal pathogens, but misuse of diagnostics can lead to inappropriate antibiotic use and excess financial burdens. Ensuring appropriate use of diagnostics is crucial for optimizing patient care and promoting stewardship of health care resources. Objective: To elicit parents' and clinicians' perspectives on expectations for care of pediatric diarrhea with a focus on diagnostic testing and to evaluate the potential for an electronic clinical decision support tool (ECDST) to improve appropriate use of diagnostics. Design, Setting, and Participants: In this qualitative study, purposeful sampling was used to recruit parents of children who had sought care for diarrhea and clinicians who care for children with diarrhea from 5 urgent care sites and 1 emergency department in Utah. Recruitment ended after achievement of inductive thematic saturation. Participants were interviewed between June 15, 2023, and January 24, 2025. Main Outcome and Measures: Key themes on expectations for management of pediatric diarrhea and perceptions of an ECDST. Interviews elicited expectations for diagnostic testing and treatment of pediatric diarrhea as well as the perceived utility of an ECDST. Analysis followed an applied thematic analysis framework. Results: Forty-four parents (40 [91%] female; median age, 34 years [range, 21-47 years]) and 16 clinicians (11 [69%] female; median age, 42 years [range, 29-59 years]) were interviewed. Three motivators were identified for parents to seek clinical care for a child with diarrhea: (1) reassurance, (2) understanding the cause of symptoms, and (3) appropriate treatment. Parents viewed diagnostic testing as a tool for meeting these expectations. Clinicians expressed skepticism for the value of diagnostics in informing etiology or treatment but reported that they may order diagnostics to reassure parents. Many clinicians acknowledged the benefits of an ECDST to assist with evidence-based decision-making for diagnostics and facilitate communication with families. Conclusions and Relevance: This qualitative study identified both similarities and tensions between parents and clinicians in expectations for pediatric diarrhea care, especially pertaining to the role of diagnostics. The findings suggest that strategies such as the use of ECDSTs are needed to resolve tension in care expectations, facilitate diagnostic stewardship, and optimize care for pediatric diarrhea.