Inpatient versus outpatient management of low-risk pediatric febrile neutropenia: Measuring parents' and healthcare professionals' preferences

Purpose Our primary objective was to describe and compare parents' and healthcare professionals' strength of preference scores for outpatient oral antibiotic relative to inpatient parenteral antibiotic treatment for low-risk febrile neutropenic children. Our secondary objective was to identify predictors of strength of preference for oral outpatient treatment. Methods Respondents were parents of children receiving cancer chemotherapy, and pediatric oncology healthcare professionals. First, the inpatient and outpatient options were described, and the respondent indicated their initially preferred option. The respondent next ranked how important seven factors (including fear/anxiety and comfort) were in making their initial choice. The threshold technique was then used to elicit the respondent's strength of preference score for oral outpatient, relative to parenteral inpatient management. Results There were 75 parent and 42 healthcare-professional respondents. There was no significant difference (P = .08) in the proportions of parents (40 of 75; 53%) and healthcare professionals (30 of 42; 71%) who initially would choose outpatient management. For parents, stronger preference for oral outpatient therapy was associated with higher anticipated quality of life for the parent and child at home relative to hospital, lower and higher importance rank for comfort. Conversely, importance rank for fear/anxiety, for professionals, only lower importance rank for fear/anxiety was associated with higher strength of preference scores for outpatient oral antibiotic management. Conclusion Only of 53% parents would choose outpatient oral antibiotic management for low-risk febrile neutropenia. Predictors of strength of preference scores for outpatient oral antibiotic relative to inpatient parenteral antibiotic treatment differed between parent and professional respondents. (C) 2004 by American Society of Clinical Oncology.