A. M. Morgan1, Y. Hu1,2, G. M. Lockwood3 1Feinberg School Of Medicine – Northwestern University,Chicago, IL, USA 2Ann & Robert H. Lurie Children’s Hospital of Chicago,Chicago, IL, USA 3University Of Iowa,Iowa City, IA, USA
Introduction: Newborn circumcision is the most common surgical procedure performed in the United States. Like any surgery, circumcision has inherent medical benefits and risks, with some adverse events requiring reoperation. Professional medical organizations stress that access to circumcision in newborn males and third-party payer coverage is justified, but the ultimate decision of whether to circumcise should be left to parental discretion. There is a paucity of data regarding how parents gather and process information in order to make this decision.
Methods: Between March and June of 2017, semi-structured open-ended interviews were conducted with mothers of newborn males during their postpartum hospitalization. Purposeful sampling with a random component was employed to ensure inclusion of subjects of differing races, ethnicities, and religions, as well as decisions to circumcise. Interviews were audio recorded and transcribed. Each transcript was coded by multiple independent reviewers, using a grounded theory approach to identify emergent themes regarding attitudes towards, sources of information about, and decision-making surrounding circumcision.
Results: Ten mothers were interviewed, of whom six planned to circumcise and four did not. Major themes emerged with regards to the decision to circumcise: the importance of cultural norms, limited yet influential discussions, and the lack of, but desire for, more knowledge (Table). Mothers’ decisions were strongly influenced by cultural and familial norms. Many parents had only very limited discussions, if any, about the decision and procedure with one another and with medical providers. Parents who had thorough conversations with their physicians found provider input to be highly influential. Parents’ baseline knowledge of the risks and benefits of the procedure was limited and not evidence-based. They uniformly desire more information and counseling from their medical providers.
Conclusion: In this cohort, parental decision to circumcise was primarily driven by social and cultural influences, particularly father’s circumcision status. Parents often lack empiric knowledge about the procedure, and conversations with medical providers are very limited. Provider knowledge and willingness to discuss the risks and benefits of circumcision with parents is vital to improving shared decision-making and empowering parents to make informed circumcision decisions consistent with their own values. Decision aids with current and evidence-based information regarding circumcision may help both parents and providers to openly discuss this controversial topic and fill a critical information gap.
