WIP 96 - Understanding family-level decision-making when seeking access to acute surgical care for children: Pilot results from a mixed methods study

Poster Number: WIP 96
Publication Number: WIP 96.889

Background: Despite increasing recognition of the impact of family experiences and social determinants of health (SDOH) on clinical outcomes, there is limited understanding of how these factors impact family decision-making when seeking surgical care for children. Appendicitis is a common proxy condition to examine disparities in pediatric surgical care, and increased understanding of how family-level factors and SDOH influence family decision-making may inform novel strategies to mitigate disparities.

Objective: Our objectives are to identify key family experiences that contribute to family-level decision-making when accessing surgical care for children with appendicitis and examine association with rates of perforation (a proxy measure for delays in care).

Design/Methods: We are conducting a prospective, cross-sectional mixed methods study. Participants include English and Spanish-speaking parents of children (0-17 years) with acute appendicitis at two academic health systems. Parents are administered the Adult Responses to Children’s Symptoms (ARCS) survey, the Adverse Childhood Experiences survey, the Accountable Health Communities Health-Related Social Needs Screening Tool, and the Single Item Literacy Screener. Parallel ARCS data is collected from child participants (8-17 years). Nested concurrent, purposive sampling is being used to select families for in-depth interviews across perforation status, race, ethnicity, socioeconomic status, and rurality to understand experiences across populations. Enrollment began in August 2023 with approval from research ethics boards at Duke University (Pro00106075) and Carilion Medical Center (IRB22635). Analysis of pilot data from the first 40 participants will be completed by April 2024. Fisher’s exact test will be used to examine associations between demographics, SDOH, and ARCS scores on perforation rate with effect size reported. Qualitative data will be analyzed using thematic analysis and integrated with quantitative data to identify themes that inform a conceptual model of family decision-making during access to surgical care.