Assessing the quality of shared decision making for elective orthopedic surgery across a large healthcare system: cross-sectional survey study

Abstract

Background Clinical guidelines recommend engaging patients in shared decision making for common orthopedic procedures; however, limited work has assessed what is occurring in practice. This study assessed the quality of shared decision making for elective hip and knee replacement and spine surgery at four network-affiliated hospitals. Methods A cross-sectional sample of 875 adult patients undergoing total hip or knee joint replacement (TJR) for osteoarthritis or spine surgery for lumbar herniated disc or lumbar spinal stenosis was selected. Patients were mailed a survey including measures of Shared Decision Making (SDMP scale) and Informed, Patient-Centered (IPC) decisions. We examined decision-making across sites, surgeons, and conditions, and whether the decision-making measures were associated with better health outcomes. Analyses were adjusted for clustering of patients within surgeons. Results Six hundred forty-six surveys (74% response rate) were returned with sufficient responses for analysis. Patients who had TJR reported lower SDMP scores than patients who had spine surgery (2.2 vs. 2.8; p < 0.001). Patients who had TJR were more likely to make IPC decisions (OA = 70%, Spine = 41%; p < 0.001). SDMP and IPC scores varied widely across surgeons, but the site was not predictive of SDMP scores or IPC decisions (all p > 0.09). Higher SDMP scores and IPC decisions were associated with larger improvements in global health outcomes for patients who had TJR, but not patients who had spine surgery. Conclusions Measures of shared decision making and decision quality varied among patients undergoing common elective orthopedic procedures. Routine measurement of shared decision making provides insight into areas of strength across these different orthopedic conditions as well as areas in need of improvement.

Preference Sensitive Care and Shared Decision-Making in Lumbar Spinal Stenosis

“…Ten studies examined the role of SDM or preference sensitivity in effecting treatment choice (62.5%) 27,30,31,33,35–39,42 . Specifically, one study (6.25%) quantified the prevalence of SDM and IPC, through SDMP and DQI respectively, in patients who underwent surgery for LSS compared with total joint arthroplasty and found that those pursuing surgery for LSS were more likely to undergo SDM, yet less likely to make an IPC decision 38 . Five studies (31.25%) specifically studied the influence of DAs on final treatment choice 27,30,31,36,37 .…”

“…Four studies (25%) used an externally validated instrument to quantify SDM or informed patient care (IPC), that is, patients making decisions based on accurate information and knowledge. [36][37][38][39] Specifically, 2 studies utilized the Shared Decision-Making Process (SDMP Scale), 36,38 2 studies utilized the Decision Quality Instrument (DQI) for LSS, 37,38 1 used the CollaboRATE Scale, 36 and 1 used the Ideal Patient Autonomy Scale. 39 Furthermore, 4 studies (25%) specifically investigated the frequency of DA administration and/or patient utilization (Supplemental Table 1, Supplemental Digital Content 2, http://links.lww.…”

“…27,30,31,33,[35][36][37][38][39]42 Specifically, one study (6.25%) quantified the prevalence of SDM and IPC, through SDMP and DQI respectively, in patients who underwent surgery for LSS compared with total joint arthroplasty and found that those pursuing surgery for LSS were more likely to undergo SDM, yet less likely to make an IPC decision. 38 Five studies (31.25%) specifically studied the influence of DAs on final treatment choice. 27,30,31,36,37 Two of these studies (12.5%) found the use of DAs (video and booklet) to not lead to an increase in patients receiving their preferred treatment 37 and generally shifted patients away from surgery 36 in a cohort of patients seeking care for common orthopedic pathologies, including LSS.…”

“…Valentine, 2021 38 SDM and decision quality varied among patients undergoing common elective orthopedic procedures.…”

“…Generally, SDM was high in patients undergoing surgery; however, Valentine et al 27 found that patients did not undergo IPC decisions offering the explanation that patients had difficulty understanding spine surgery concepts and expected benefits regarding nerve pain versus back pain. 38 DAs generally increased IPC; however, mixed results followed the choice to undergo surgical or conservative treatment in LSS. 27,30,31,36,37 Similarly, DAs have been found to reduce patient indecision across elective surgery; however, DAs have generally been found to increase the proportion of patients seeking conservative management.…”