Project 465473

Incorporating shared decision making with children and families hospitalized on the general pediatric ward was one of the Top 10 priorities identified by Canadian parents, families, and healthcare professionals. Engaging families in medical decision making is an important principle in patient and family-centred care, and one that improves clinical outcomes. Yet, there is limited evidence of parent and family involvement in shared decision making in hospital. Bronchiolitis, a seasonal lower respiratory tract infection usually caused by viruses, is the most common cause of hospitalization in young Canadian children. Typically, children experience runny nose, cough and a low-grade fever followed by difficulty breathing and feeding. One of the main reasons for admission to hospital is because infants are unable to feed or considered unsafe to drink by mouth as they are breathing so fast. When this happens, infants are given fluids either using an intravenous (IV) catheter or using a feeding tube that is passed through the nose into the stomach (nasogastric or NG tube). Both IV and NG fluids are safe, but have different side effect profiles. Currently, we do not know if parents are involved in choosing whether their child gets IV or NG fluids. Therefore, we plan to conduct a large study across multiple Canadian hospitals of over 540 infants who are admitted to hospital with bronchiolitis and need IV or NG fluids. We will collect information on whether healthcare providers involve parents in shared decision making, parent knowledge of fluid options, the benefits and harms of IV vs. NG fluids, and the perspectives of parents and healthcare workers about IV vs. NG fluids. We will then develop and test a decision aid that can be used to help parents choose between IV and NG fluids. The proposal will inform evidence-based management of bronchiolitis and clinical practice guidelines with the goal of involving families in decision making for their children.