Current concepts of shared decision making in orthopedic surgery

Abstract

Purpose of review The Shared Decision Making (SDM) model, a collaborative decision making process between the physician and patient to make an informed clinical decision that enhances the chance of treatment success as defined by each patient's preferences and values, has become a new and promising tool in the healthcare process; however, minimal data exists on its application in the orthopedic surgical specialty. Increasing evidence has demonstrated that this once novel idea can be implemented successfully in the orthopedic setting to improve patient outcomes. Recent findings SDM can be applied without significant increases in the office length. Patients report that a physician that takes the time to listen to them is among the most important factors in their care. When time was focused on the SDM process, there was a direct correlation between the time spent with a patient and patient satisfaction. Patients exposed to a decision aid prior to surgery gained a greater knowledge from baseline to make a higher quality decision that was consistent with their values. Involving family members preoperatively can help all patients adhere to postoperative regimens. Exposing patients to a decision aid can reduce expensive elective surgeries, in favor of non-operative management. Incorporating patient goals into the decision-making process has increased satisfaction, compliance, and outcomes.Summary SDM is a two-way exchange of information that attempts to correct the inequality of power between the patient and physician. Decision-aids are helpful tools that facilitate the decision-making process. Treatment decisions are consistent with patient preferences and values when there may be no "best" therapy. A good patient-physician relationship is essential during the process to reduce decisional conflict and increase overall patient outcomes.

Classification of the appropriate behaviors of Patients for Patient Safety against the Chinese cultural background, based on grounded theory

“…The content of patients' participation in decision-making is more than mentioned above, but it is enough to show that among the appropriate behaviors of PFPS, some decision-making behaviors (making choices or signing consent forms) will directly affect patient safety. This is consistent with the requirement of sharing decision-making responsibilities, based on the information sharing between doctors and patients, and on selecting the best care plan according to the individual situation of the patient [11].…”

A shared decision‐making tool for obstructive sleep apnea without tonsillar hypertrophy: A randomized controlled trial

“…A 2014 study of 1,034 adult patients presenting to an ambulatory surgery center reported that only 55% of participants characterized their preoperative decision making as shared with their physician . A review of SDM in orthopedic surgery found that it did not significantly increase the duration of office visits and that time spent with the patient in the SDM process correlated with increased patient satisfaction . These authors also reported that implementation of SDM required mechanisms and the introduction of a new infrastructure as well as experience and training for both patients and providers.…”

“…24 A review of SDM in orthopedic surgery found that it did not significantly increase the duration of office visits and that time spent with the patient in the SDM process correlated with increased patient satisfaction. 25 These authors also reported that implementation of SDM required mechanisms and the introduction of a new infrastructure as well as experience and training for both patients and providers. A 2017 Cochrane review found that decision aids increased the likelihood that patients would select a management option at the conclusion of the visit.…”

The Feasibility and Usability of a Ranking Tool to Elicit Patient Preferences for the Treatment of Trigger Finger

“…7,8 For example, the SHARE approach, developed by the Agency for Healthcare Research and Quality, includes advice to: (1) seek your patient' s participation, (2) help your patient explore and compare treatment options, (3) assess your patient's values and preferences, (4) reach a decision with your patient, and (5) evaluate your patient' s decision. 9 Prior work shows that SDM improves patient confidence, 10,11 compliance, 12 and participation in their treatment, 11 and increases patient satisfaction with their visit. 10 Patients also prefer taking an active role in their decision making through an SDM approach.…”

“…Currently, no standard process to help patients prioritize their preferences for treatment attributes exists, despite extensive work demonstrating the complexity of decision making in the setting of competing attributes. 10,12,17,18 As patient-centered care becomes increasingly emphasized, a process to elicit patient preferences at the point of care is needed. As such, there are efforts to develop tools helping patients rank their preferences for competing treatment attributes.…”