

26 July 2010
Best practice described in case of ambiguous genitalia
George Atkinson
Writing in the Journal of Pediatric Endocrinology and metabolism, doctors have proposed a set of guidelines for when genital surgery is studying to make the appearance of a typical child sex in order to facilitate the development of gender identity.
The researchers suggest an approach to decision making in six steps to provide health care providers the opportunity to clarify the reasons for their recommendations, identify and fill gaps in the understanding of parents of your child's diagnosis and treatment options and explore the underlying values to the concerns of parents and doctors.
"The big question we are dealing with is that there is no standard approach or best practice for doctors and family members to continue to address decisions to babies born with disorders of sexual development," said Alexander Kon, Faculty of medicine at UC Davis study author.
Disorders covered by the guidelines include a wide range of conditions such as those in which infants are born with genitalia have male and female attributes, and infants whose genitals is atypical for sex because it is more for a female or elsewhere masculinzed bass-masculinized for a male.
Doctors, generally agreed that there is a need for a process clearly defined for medical decision-making in these cases. The authors of the study have applied this recommendation in the process to consider elective genital surgery, or genitoplasty, for children born with atypical sexual development. In the past, such decisions have been driven by doctors and parents personal values and "gut feelings," often with less optimal results, the study says.
Providers of health care often report feeling conflicted if made recommendations suitable for families and parents reported feeling rushed in decision-making.The researchers said that shared decision-making would require caregivers clinical reveal his reasoning, values and biases and explore their patients or their feelings of alternates.
Kon and his co-researchers recommended six steps for shared decision-making: set the stage and develop suitable equipment, for example, including all necessary subspecialists for a complex decision and ensure that parents are comfortable with the team members.Setting preferences for information and decision-making roles ensure that parents have access to the amount of information you want in the way they want to receive it.Perceive and deal with the emotions associated with the decision-making process to ensure that they recognized the need for parents to obtain information and their feelings about the decision.Parents who are too worried about atypical genitals of children may not be willing to participate effectively in the decision-making process and may be unable to offer truly measure informado.La possible permission, parents who are experiencing strong emotional reactions need help deal with these feelings of authorizing elective surgery.Set the concerns and values, from how doctors framing discussions with parents can have a significant impact on how a family can perceive the circumstances and his son.If the problem is defined as "abnormal genitalia", the answer may be different "challenges grow with an atypical body".the discussion, must therefore change discussion outside of the choice of whether or not having surgery to "how to better address concerns that we have identified?"Identify options and provide evidence of an objective way, presenting options and the tests associated with options disponibles.Los suppliers should strive to objectivity, convey what you think that the team is the best course of action and why he is supported by shared pruebas.Responsabilidad for a decision is facilitated through the process of six pasos.Los parents must have received objective information and emotional support to help them make decisions racionales.El health care team will have acquired knowledge on the priorities of the parents and family circumstances, is expected to lead to a consensus based on trust and understanding.
"" Pediatric literature suggests that around a quarter of families want completely oriented to the family decision-making and another quarter want completely driven by the doctor taking of decisions,"said Kon.""The other half want shared decision-making decisiones.Hemos trying to develop a process to enable families to feel comfortable with express their feelings and values in a scenario that involves also to doctors, nurses, chaplains, and others in the process."
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Source: Journal of Pediatrics Endocrinology and metabolism
View the original article here