Introduction: Informed consent is obtained prior to circumcision of newborn males, but little is known about the degree of uncertainty parents experience surrounding the choice of whether or not to circumcise. We evaluated the degree of decisional conflict (DC) in parents of male children and children of unknown sex during the prenatal period.
Methods: We administered a validated questionnaire, the Decisional Conflict Scale (DCS), to pregnant mothers carrying a male child or child of unknown sex during prenatal care visits as well as to expecting parents via an institution-wide survey. DCS total score was calculated on a scale of 0 to 100, with 0 representing no DC, and 100 representing extremely high DC. Total score, as well as uncertainty, informed, values clarity, support, and effective decision subscores were calculated. Decisional conflict was considered to be low with a score of less than 25, intermediate with scores between 25 and 37.5 and high with scores greater than 37.5. Unpaired t-test was used to compare results between groups.
Results: 153 DCS were completed and analyzed. All mothers approached for survey completion during prenatal visits completed the survey. 57.9% (n=88) of respondents reported they would choose circumcision for their male child, with 33% (n=51) choosing not to circumcise, and the remaining 8.6% (n=13) unsure about the choice. Mean total DCS score was higher (mean = 44.4, SD 11.9) for parents reporting they were unsure, than those who selected circumcision (mean = 12.9, SD 14.2; p<0.0001) or no circumcision (mean = 5.5, SD 8.7; p<0.0001). Mean scores were not significantly different from trimester to trimester, and the number of those unsure about the decision were spread evenly between the first, second and third trimesters. Subscale scores were all low for conflict in those who had decided on circumcision or against it. All subscale scores in the unsure group were high, with the highest being the uncertainty subscale (mean = 62.8, SD 15.8) and the values clarity subscale (mean = 48.1, SD 14.9).
Conclusions: Our survey data showed that a small proportion of parents-to-be do experience high levels of DC regarding the decision of whether or not to circumcise. Importantly, some parents report not understanding the risks, benefits, and side effects of this procedure, as reflected in the informed subscore or understanding the relative importance of their own values in this decision, as reflected in the values clarity subscore. Better understanding of the modifiable factors contributing to this hesitancy could help providers alleviate conflict and regret regarding this decision.