Shared Decision Making in Patients with Osteoarthritis of the Hip and Knee

Bozic, Kevin J.; Belkora, Jeffrey; Chan, Vanessa; Youm, Jiwon; Zhou, Tianzan; Dupaix, John P.; Bye, Angela Nava; Braddock, Clarence H.; Chenok, Kate Eresian; Huddleston, James I.

doi:10.2106/jbjs.m.00004

Cited by 172 publications

(198 citation statements)

References 15 publications

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“…The patient and family can go over the parts important to them repeatedly at home at their own pace. Decision aids help patients explore their own preferences and values and participate more fully in decision-making [5,17,26]. These tools improve the patients' knowledge regarding options, reduce their decisional conflict, and seem to decrease rates of discretionary surgeries [17,26].…”

Section: Discussionmentioning

confidence: 99%

Do Surgeons Treat Their Patients Like They Would Treat Themselves?

Janssen

Teunis

Guitton

et al. 2015

Clinical Orthopaedics &Amp; Related Research

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Background There is substantial unexplained geographical and surgeon-to-surgeon variation in rates of surgery. One would expect surgeons to treat patients and themselves similarly based on best evidence and accounting for patient preferences. Questions/purposes (1) Are surgeons more likely to recommend surgery when choosing for a patient than for themselves? (2) Are surgeons less confident in deciding for patients than for themselves?Methods Two hundred fifty-four (32%) of 790 Science of Variation Group (SOVG) members reviewed 21 fictional upper extremity cases (eg, distal radius fracture, De Quervain tendinopathy) for which surgery is optional answering two questions: (1) What treatment would you choose/recommend: operative or nonoperative? (2) On a scale from 0 to 10, how confident are you about this decision? Confidence is the degree that one believes that his or her decision is the right one (ie, most appropriate). Participants were orthopaedic, trauma, and plastic surgeons, all with an interest in 123 Clin Orthop Relat Res (2015) 473:3564-3572 DOI 10.1007/s11999-015-4304-z Clinical Orthopaedics and Related Research ® A Publication of The Association of Bone and Joint Surgeons® treating upperextremity conditions. Half of the participants were randomized to choose for themselves if they had this injury or illness. The other half was randomized to make treatment recommendations for a patient of their age and gender. For the choice of operative or nonoperative, the overall recommendation for treatment was expressed as a surgery score per surgeon by dividing the number of cases they would operate on by the total number of cases (n = 21), where 100% is when every surgeon recommended surgery for every case. For confidence, we calculated the mean confidence for all 21 cases per surgeon; overall score ranges from 0 to 10 with a higher score indicating more confidence in the decision for treatment. Results Surgeons were more likely to recommend surgery for a patient (44.2% ± 14.0%) than they were to choose surgery for themselves (38.5% ± 15.4%) with a mean difference of 6% (95% confidence interval [CI], 2.1%-9.4%; p = 0.002). Surgeons were more confident in deciding for themselves than they were for a patient of similar age and gender (self: 7.9 ± 1.0, patient: 7.5 ± 1.2, mean difference: 0.35 [CI, 0.075-0.62], p = 0.012). Conclusions Surgeons are slightly more likely to recommend surgery for a patient than they are to choose surgery for themselves and they choose for themselves with a little more confidence. Different perspectives, preferences, circumstantial information, and cognitive biases might explain the observed differences. This emphasizes the importance of (1) understanding patients' preferences and their considerations for treatment; (2) being aware that surgeons and patients might weigh various factors differently; (3) giving patients more autonomy by letting them balance risks and benefits themselves (ie, shared decisionmaking); and (4) assessing how dispassionate evidencebased decision aids help...

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Section: Discussionmentioning

confidence: 99%

Do Surgeons Treat Their Patients Like They Would Treat Themselves?

Janssen

Teunis

Guitton

et al. 2015

Clinical Orthopaedics &Amp; Related Research

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“…Patient choices increasingly benefit from price transparency 3 , the inclusion of patient-reported outcomes in quality measurement 4 , and mechanisms to encourage shared decision-making with physicians 5 .…”

mentioning

confidence: 99%

Consumer Choice Between Hospital-Based and Freestanding Facilities for Arthroscopy

Robinson¹,

Brown²,

Whaley³

et al. 2015

The Journal of Bone and Joint Surgery

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“…In fact, most patients in the joint surgery group described an informed decision-making process in which patients independently deliberated and made a treatment decision, while the individual physicians focused on providing education regarding treatment options [14]. Reasons for the limited use of shared decision making include scarce familiarity and training among surgeons, cost and logistical challenges related to the implementation of shared decision-making programs, and a limited comparative-effectiveness research base available for developing shared decision aids [14,15]. Another possibility is that surgeons have liability concerns due to procedural risks [16].…”

Section: Discussionmentioning

confidence: 99%

The Impact of Screening, Medical Treatment and Invasive Interventions on Patients' Medical Decision-Making Styles: A Cross-Sectional Study with Inferences to the United States Population

Maldonato¹,

Sperandeo²,

Orco³

et al. 2017

J Psychol Psychother

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Background: Although positive benefits are associated with shared decision making, no previous studies have evaluated the impact of condition on how shared decision making is implemented.Objective: To compare decision-making preferences across three conditions associated with screening, medical treatment, and invasive interventions: Screening tests for colorectal cancer, initiation of prescription medication for hypertension, and surgical treatment for hip or knee osteoarthritis. Methods:We made use of the publicly available National Survey of Medical Decisions (the DECISIONS study) data and our sample comprised of all subjects who completed the following three specific modules of the decisions study: Colorectal cancerscreening tests, high blood-pressure medication, and knee or hip replacement surgery. Our primary outcomes of interest were (1) Who made the final decision? (2) Extent of patients' involvement in the decision, and (3) How confident they were about their decision.Results: When comparing baseline characteristics across the three conditions, the group undergoing screening was youngest with a mean age of 58.7 years compared to the medication group (61.27 years), while the group undergoing surgery was oldest (63.14 years). Females constituted over half of all three groups (greater than 50%). In the invasive interventions, decisions were made mainly by the patients, unlike the other groups where shared decision making was predominant. Most patients in all three groups preferred high levels of participation in decision making. Patients undergoing surgery were significantly more likely to have greater confidence in their decisions, followed by patients with medication for hypertension. Conclusion:Shared decision making is less predominant among invasive interventions. Further research should describe the reasons for the limited use of shared decisions among conditions with invasive interventions, along with its consequences for healthcare quality.

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Shared Decision Making in Patients with Osteoarthritis of the Hip and Knee

Abstract: Decision and communication aids used in orthopaedic practice had benefits for both patients and surgeons. These findings could be important in facilitating adoption of shared decision-making tools into routine orthopaedic practice.

Cited by 172 publications

References 15 publications

Do Surgeons Treat Their Patients Like They Would Treat Themselves?

Do Surgeons Treat Their Patients Like They Would Treat Themselves?

Consumer Choice Between Hospital-Based and Freestanding Facilities for Arthroscopy

The Impact of Screening, Medical Treatment and Invasive Interventions on Patients' Medical Decision-Making Styles: A Cross-Sectional Study with Inferences to the United States Population

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