Peer-reviewed article
Factors influencing shared decision-making in microtia reconstruction: A systematic review.
Zhu AQ, Yu SE, Luu K, Brodie KD ·
Summary
Written by AI, not yet AICS's view · claude-haiku-4-5-20251001This systematic review examined how children with microtia and their caregivers make decisions about ear reconstruction surgery. The review analyzed five studies involving 235 participants (patients aged 3-17, caregivers, and healthcare providers) to understand what factors influence the decision-making process. Fear of social stigma and concerns about psychosocial impacts pushed families toward early surgery, while prioritizing the child's involvement tended to delay it. Children wanted to participate in decisions but faced challenges including difficulty recalling information and unclear expectations about when they could meaningfully contribute to choices.
Key points
- Fear of social stigma and negative psychosocial impacts (convergence score 8/10) motivated early surgical intervention
- Some children felt positive about their condition and argued that bullying concerns should not drive the decision to have surgery (5/10)
- Patients desired involvement in shared decision-making and believed their preferences should guide treatment choices (5/10)
- Children had difficulty recalling pre-operative information provided in childhood (4/10)
- Both patients and caregivers lacked clarity on the appropriate age for children to make informed decisions and how to involve them meaningfully
Limitations
The review identified only five studies and does not report on outcomes of surgery itself or long-term satisfaction; it cannot tell us whether earlier or later surgery produces better psychosocial outcomes for children, nor does it compare decision-making processes across different healthcare systems or cultural contexts.
Abstract
Background The decision to pursue microtia reconstruction is highly personalized, requiring shared decision-making (SDM). This systematic review analyzes patient and caregiver motivations and priorities guiding the SDM process to help inform clinician-led discussions. Methods A systematic review evaluated studies from 1/1/1990 to 4/25/2025. Included articles focused on SDM in pediatric microtia reconstruction. Descriptive analyses were performed. Results Five articles met criteria, including 235 study participants: 69 patients (ages 3 to 17 at time of surgery), 134 caregivers, and 32 healthcare providers. Key themes were aggregated into a convergence table and given a score (out of 10) representing the strength of convergence of the theme across studies. Various conflicting factors influenced timing of surgery. Fear of social stigma (convergence score: 8/10) and negative psychosocial impacts (8/10) motivated early intervention. Prioritizing patient involvement in decision-making led to delaying surgery. Child involvement in decision-making ranged from unilateral parental decision-making to waiting until patients could make the decision for themselves. Patient motivations for surgery were driven by the negative impacts of microtia (6/10). However, some children highlighted positive aspects and argued that concern for bullying should not influence the decision to pursue surgery (5/10). Microtia patients desired involvement in the SDM process and believed patient preferences should drive decision-making (5/10). However, patients acknowledged the impact of parental influence and had difficulty recalling pre-operative information they had received as a child (4/10). Both patients and caregivers lacked clarity on when children could make informed decisions and how to involve them. Conclusions Though caregivers significantly influence the SDM process regarding ear reconstruction, microtia patients desire to be heavily involved in treatment decisions. Further research regarding age at which children can assent and SDM tools could benefit this patient population.