Surgeons' views on hypospadias care journey: A qualitative study

Background Three major parties are involved in the hypospadias treatment journey- the patient, their parents/ carers, and the surgeon. There is a strong trend towards involving all three, where possible, in deriving evidence around the care pathways. Currently, there are little data available on surgeons' perspectives of distal hypospadias care. Aim This study explored the reflections of Australian and Aotearoa New Zealand Paediatric hypospadias surgeons on the journey and experience of children born with distal hypospadias and their families, with the aim to improve this journey to achieve a better healthcare experience and satisfaction. We sought to understand a) what informs the content and process of a hypospadias surgeon's consultation with parents/carers, b) how hypospadias surgeons negotiate surgical outcomes, parents/carers' views and preferences, social circumstances, cultural context, and their clinical opinions and treatment recommendations, and c) how surgeons perceive the journey for families with a child born with distal hypospadias could be improved. Methods We conducted a qualitative descriptive study to generate rich descriptions of the lived experiences of hypospadias surgeons caring for children with distal hypospadias and their families. Data were collected using semi-structured interviews with nine paediatric hypospadias surgeons in Australia and Aotearoa New Zealand. All participants had routinely practised hypospadias surgery as a consultant for at least five years. Participants were purposively sampled to obtain a diverse representation of perspectives. Data were collected and analysed using the reflexive thematic analysis methodology. Results Two overarching themes reflecting the lived experiences of paediatric hypospadias surgeons emerged: The journey is as varied as the children and their families, and The best possible journey. The first overarching theme is characterised by three themes: Journey feature, Journey process, and Journey influences, each illuminating main elements informing participants' perspective of the treatment journey. Surgeons perceive the journey as highly individualised; they mark the start of the journey differently but put a great emphasis on the consultation and identify several essential parts of it. The second overarching theme reflects participants' ideas on key elements of hypospadias care that could improve the treatment journey, such as better information for carers and non-surgeon healthcare providers, more communication training for surgeons in their formative years, and societal acceptance of anatomical variance. Conclusion The journey of children and families is perceived by surgeons as variable, individualised, and affected by different influences. Those influences highlight the importance of knowing your patient/family and creating tailored, individualised, family-centred communication and care.