Dupuytren contracture: using qualitative data to inform a conceptual framework for shared decision-making

Abstract

Multiple treatment options are available to patients with Dupuytren contracture, making shared decision-making complex. Our rigorous qualitative analysis sought to understand patient perceptions of shared decision-making in Dupuytren contracture treatment and create a conceptual framework to optimize patient-physician communication. We interviewed 30 patients with Dupuytren contracture to learn about their experience with treatment selection. The following themes were integral to shared decision-making for Dupuytren contracture treatment: discussing disease progression and treatment initiation, presenting all available treatment options, assessing patients’ pre-existing biases towards treatment, patient values and preferences for treatment trade-offs, treatment risks and benefits, physician recommendation and active patient participation. This model can optimize communication about treatment options and expectations for relevant outcomes including, recovery time, contracture recurrence, complications, and treatment-related expenses. Level of evidence: V

Microfasciectomy in Dupuytren’s disease: microsurgery in the evolution toward safer and more efficient fasciectomy and hand surgery

“…The disease is highly prevalent: nodules or strands can be found in up to 30% of the population over 50 years, although a minority may seek medical attention or even require treatment due to functional disability ( 2 , 3 ). Treatment modalities to correct the finger contractures are variable in invasiveness, which impacts recovery time, complication risks and chances of recurrence ( 4 ). Minimal invasive techniques such as needle fasciotomy and collagenase injections have a faster recovery, but incomplete correction and recurrence are markedly more frequent than open surgery ( 5 ).…”