Original article
Patient, parent, and physician perspectives on pediatric oncology rounds*

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To provide data to guide physicians regarding the extent to which pediatric patients and their families should be involved in decision-making discussions by their health care teams, we compared the standard rounding procedure in a pediatric oncology unit (rounds conducted out of earshot) with bedside rounds in which management was discussed in front of patients and parents. Type of rounds was alternated in 2-week blocks for 4 months. The impact of the two types of rounds of 35 parents and children was studied. Parents preferred bedside rounds to standard rounds, and perceived increased opportunifies to obtain information and ask questions. Parents and children differed, in their reports of how much bedside rounds upset children. Older children, compared with younger children, more strongly disliked standard rounds; this appeared to be related to feelings of exclusion. The two types of rounds differed in their effectiveness in providing specific types of education to residents. The finding suggest that bedside rounds have a positive impact on parents' attitudes toward physicians, that they do not dilute the child's sense of relationship with the primary attending physician, and that they contribute to certain aspects of resident education.

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    Notwithstanding, a study of hospitalised paediatric patients supports that when given the option to attend, 85% of parents participate in bedside rounds (Muething et al., 2007). Others have noted that participation in bedside rounds affords individuals the opportunity to obtain valuable information (Lewis, 1988) and that communication practices can impact patient outcomes (Wanzer et al., 2004). A quality improvement initiative permitting parents to be present at bedside rounds in a paediatric ICU found that this practice was perceived to be beneficial by physicians, nurses and parents (Kleiberg et al., 2006).

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    The parents’ preference for family-centered rounds and lack of concern regarding confidentiality may be explained by the demographic characteristics of the parents: Most of the parents participating in this study had a secondary education or higher. Higher education has been associated with negative attitudes about bedside rounds (Lewis et al., 1988) and decreased privacy concern (Aronson et al., 2009). Aronson et al. (2009) has determined that family preferences are influenced by day of admission.

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Supported in part by a grant from the Academic Senate, University of California, and the Department of Social Work, University of California, San Francisco.

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