106 / 240
tube insertion, the risk of tympanic membrane perforation
(17%) was most commonly recalled. Thirty-six parents
recalled as many benefits as were mentioned during the
visit, and 21 parents recalled as many risks as were men-
tioned during the child’s consultation. Overall, parents
recalled one-third the risks of surgery and half the benefits
of surgery mentioned by the surgeons.
Nine (10.7%) parents reported that no benefits were dis-
cussed during the consultation; the video analysis showed
that 1 of these parents had 2 benefits mentioned during con-
sultation. Ten (11.9%) parents reported that no risks were
mentioned; however, in 5 consultations, risks were men-
tioned. Two (2.4%) parents reported that benefits were
reviewed during the appointment, but they could not recall
the content of those benefits; 2 (2.4%) parents reported that
risks were mentioned but could not specify those risks.
During 4 visits (4.8%), surgeons used nonspecific language
when discussing the risks and benefits (eg, ‘‘Something bad
may happen’’), and during 1 visit, the surgeon did not expli-
citly state how surgery would improve the child’s symptoms
(eg, ‘‘These things may all get better with the surgery’’).
Overall, the participants recalled a higher proportion of
benefits than risks (
Z
=
2
4.25,
P
\
.001). When partici-
pants were divided into those who decided to proceed with
surgery (58.3%) versus those who chose watchful waiting
(41.7%), parents in the latter group were significantly more
likely to recall the risks of surgery (median = 1, SD = 1.05)
than were those who chose surgery (median = 0, SD = 0.83;
Z
=
2
3.75,
P
\
.001). No significant differences were
found in the recall of risks and benefits of surgery at the 2-
week follow-up phone call, in terms of the following: con-
sulting surgeon, type of surgery, presence of 1 or 2 care-
givers during the visit, child’s previous surgical experience,
other children’s previous surgical experience in the family,
and parental education level (
Tables 4
and
5
).
Discussion
The overall recall rate for risks and benefits of surgery was
low. Parents remembered about half the benefits of surgery
and only one-third the risks mentioned during the consulta-
tion. As well, those parents who elected to monitor their
children rather than proceed with surgery were significantly
more likely to recall the risks of surgery. Selective recall or
confirmation bias (tendency to prefer and recall information
that will confirm a person’s beliefs/hypotheses) may have
played a role, as parents may selectively recall the advan-
tages of surgical treatment because they are hopeful that it
will alleviate their children’s symptoms.
The risk recall rate found in this study was similar to that
reported in other studies in surgical settings.
5-9,12-14
A study
in pediatric surgery, for example, found that
.
20% of
parents did not recall any risks being discussed, and
\
40%
recalled the commonly mentioned risks, such as bleeding
and infection.
13
However, no studies to date have used
objective assessment of the consultation interaction and
recall of the information discussed during the visit.
Specifically, previous research has relied on what the physi-
cian remembered stating, sometimes along with an educa-
tional aid, as the information given during the consultation
and relating it to what was recalled by patients and family
members.
5,7-12,14
In our study, we used video recordings of
the physician-parent interaction to determine what specific
risks and benefits were discussed during the visit. Providers
will have different styles of interaction and deliver different
amounts of information; thus, it is important to objectively
assess exactly what information was shared during the
consultation.
Although there are a number of theoretical risks for any
surgery, some are incredibly rare and may not be mentioned
during the consultation. An unexpected finding in this study
was that several rare risks and benefits were either not men-
tioned or mentioned rarely. Furthermore, some risks and
benefits were inconsistently mentioned across providers,
even within each provider. Some benefits of surgery docu-
mented in the literature but not mentioned included
improved school performance
15
and alleviation of head-
aches
16
for children with sleep-disordered breathing. Some
risks of surgery found in the literature but not mentioned by
Table 3.
Risks and Benefits Mentioned and Recalled Associated
with Tympanostomy Tube Insertion.
Mentioned
during
Consultation
Mentioned at
2-wk Follow-up
Interview
Benefits of surgery
Reduced number of infections
31
27
Reduced number of oral
antibiotics
15
2
Reduced days of day care/
school/work missed
1
0
Improved quality of life
7
7
Temporarily improved hearing
14
7
Improved speech
development
(young children)
5
5
Easier to treat future acute
otitis media episodes
12
8
Consequences of surgery
General anesthesia
35
17
Readmission
30
11
Tympanic membrane
perforation
27
14
Otorrhea
26
4
Water precautions
26
2
Premature tube extrusion
a
2
5
Retained tube
3
1
Tube blockage
2
0
Myringosclerosis or
tympanosclerosis
a
0
1
a
Gray shading indicates that consequence was mentioned by more parents
than those who were told in the consultation visit about it.
Pianosi et al
84