DECISION-MAKING BY PARENTS AND CHILDREN IN PEDIATRIC HAND SURGERY

The task of decision-making about microvascular toe-transfer surgery i s a complex one for parents and their children. The process involves b alancing risks and benefits within the context of the emotional respon ses of the parents and the future needs of their children. This paper describes a model of clinical practice which incorporates that process through a multi-disciplinary approach. The factors which influenced p arents in their decision are examined, and the issue of the competence of the child to participate is discussed. 34 families were assessed, of whom 7 did not proceed with surgery. It was found that parents were more influenced by factors within the process, such as communication, than by concerns about technical outcome. Specialised psychological c ounselling played an integral role in the making of stable decisions.