Do Upper Extremity Trauma Patients Have Different Preferences for Shared Decision-making Than Patients With Nontraumatic Conditions?

Abstract

Background Shared decision-making is a combination of expertise, available scientific evidence, and the preferences of the patient and surgeon. Some surgeons contend that patients are less capable of participating in decisions about traumatic conditions than nontraumatic conditions. Questions/purposes (1) Do patients with nontraumatic conditions have different preferences for shared decisionmaking when compared with those who sustained acute trauma? (2) Do disability, symptoms of depression, and self-efficacy correlate with preference for shared decisionmaking? Methods In this prospective, comparative trial, we evaluated a total of 133 patients presenting to the outpatient practices of two university-based hand surgeons with traumatic or nontraumatic hand and upper extremity illnesses or conditions. Each patient completed questionnaires measuring their preferred role in healthcare decision-making (Control Preferences Scale [CPS]), symptoms of depression (Patients' Health Questionnaire), and pain self-efficacy (confidence that one can achieve one's goals despite pain; measured using the Pain Self-efficacy Questionnaire). Patients also completed a short version of the Disabilities of the Arm, Shoulder, and Hand questionnaire and an ordinal rating of pain intensity. Results There was no difference in decision-making preferences between patients with traumatic (CPS: 3 ± 2) and nontraumatic conditions (CPS: 3 ± 1 mean difference = 0.2 [95% confidence interval, À0.4 to 0.7], p = 0.78) with most patients (95 versus 38) preferring shared decisionmaking. More educated patients preferred a more active role in decision-making (beta = À0.1, r = 0.08, p = 0.001); however, differences in levels of disability, pain and function, depression, and pain-related self-efficacy were not associated with differences in patients' preferences in terms of shared decision-making. Conclusions Patients who sustained trauma have on average the same preference for shared decision-making compared with patients who sustained no trauma. Now that we know the findings of this study, clinicians might be motivated to share their expertise about the treatment options, potential outcomes, benefits, and harms with the patient and to discuss their preference as well in a semiacute setting, resulting in a shared decision.

Patients With Limited Health Literacy Have Similar Preferences but Different Perceptions in Surgical Decision-making for Carpal Tunnel Release

“…Providing patients with their desired level of involvement in decision-making is an important part of improving patient engagement and clinical results [24], and future studies are required to determine whether meeting patients' preferences actually results in better outcomes in CTS. In this regard, decision aids that are appropriate for patients with limited health literacy might help them achieve their preferred role in decision-making [16,19,23]. A physician should consider informing and recommending treatment programs for CTS with concise explanations tailored to basic levels of health literacy.…”

Desired Involvement in Treatment Decisions Among Adults with PTSD Symptoms

“…The finding that most patients preferred an active or active‐shared role, wherein they assume more control over the decision than the provider, differs from that of prior studies using the Control Preferences Scale in nonmental health samples. Studies in patients with breast cancer (Janz et al., ), traumatic injury (Hageman et al., ), and in a pooled analysis of more than 3,000 cancer patients (Singh et al., ) reported that a collaborative approach, in which the patient and provider equally share decisional control, was most preferred. It is possible that characteristic features of PTSD, including mistrust of providers or a desire to be in control of situations, may have resulted in an increased desire for decisional control.…”

Shared Decision Making and Autonomy Among US Participants with Multiple Sclerosis in the NARCOMS Registry

“…The CPS is easily administered, is valid in health-care decision making, 14 and has been used across varying disease types. [15][16][17][18] In addition, it has been adapted for selfadministration without the need for detailed instructions 19 using a 5-point visual scale (Figure 1). Research using the CPS in MS has shown high levels of autonomy in decision making and role preference variations with age, sex, and disease course.…”