Evaluating Shared Decision-Making in Treatment Selection for Dupuytren Contracture: A Mixed Methods Approach

Abstract

Background: Patients with Dupuytren contracture can receive a variety of surgical and nonsurgical treatments. The extent to which patients participate in the shared decision-making process is unclear. Methods: An explanatory-sequential mixed-methods study was conducted. Participants completed the Nine-Item Shared Decision-Making Questionnaire and the brief Michigan Hand Outcomes Questionnaire before completing semi-structured interviews in which they described their experience with selecting treatment. Results: Thirty participants [25 men (83%) and five women (17%); mean age, 69 years (range, 51 to 84 years)] received treatment for Dupuytren contracture (11 collagenase injection, six needle aponeurotomy, and 13 limited fasciectomy). Adjusted mean scores for the Shared Decision-Making Questionnaire and brief Michigan Hand Outcomes Questionnaire were 71 (SD 20) and 77 (SD 16), respectively, indicating a high degree of shared decision-making and satisfaction. Patients who received limited fasciectomy accepted invasiveness and prolonged recovery time because they believed it provided a long-term solution. Patients chose needle aponeurotomy and collagenase injection because the treatments were perceived as safer and more convenient and permitted rapid return to daily activities, which was particularly valued by patients who were employed or had bilateral contractures. Conclusions: Physicians should help patients choose a treatment that aligns with the patient’s preferences for long-term versus short-term results, recovery period and postoperative rehabilitation, and risk of complications, because patients used this information to assist in their treatment selection. Areas of improvement for shared decision-making include equal presentation of all treatments and ensuring realistic patient expectations regarding the chronic and recurrent nature of Dupuytren contracture regardless of treatment received.

OMERACT Core outcome measurement set for shared decision making in rheumatic and musculoskeletal conditions: a scoping review to identify candidate instruments

“…Questionnaire shared decision making 47,81 •Perceived shared decision making 69,84 •Rheumatoid arthritis (n=1) 81 •Juvenile idiopathic arthritis (n=1) 47 •Psoriatic arthritis (n=1) 81 •Dupuytren contracture (n=1) 69 •Anterior cruciate ligament injury (n=1) 84 shared decision making 34,41,69,81,84 -no information in which populations 69 Reliability:…”

“…•Reliable: -no information in which populations 41 •Internal consistency: -no information in which populations 69 Princess Margaret Hospital Satisfaction with Doctor Questionnaire…”

Protocol paper for SMART OPS: Shared decision-making Multidisciplinary Approach – a Randomised controlled Trial in the Older adult Population considering Surgery

“…Observational studies are predominantly in the fields of orthopaedics, plastics surgery (eg, breast reconstruction) and general surgery. [9][10][11][12][13][14][15][16] Outcomes reported are predominantly on the practice and perception of SDM: In the surgical sphere, SDM is associated with higher patient satisfaction, but clinician and patient perceptions of if it has occurred do not always align; patients with lower socioeconomic status and depression often have worse perceptions of their SDM process. Randomised controlled trials are few and heterogeneous.…”

“…The year 2022 saw a large increase in published trials (predominantly based out of North America, Canada and the Netherlands) but the heterogeneity of interventions and outcomes reported remains large. Observational studies are predominantly in the fields of orthopaedics, plastics surgery (eg, breast reconstruction) and general surgery 9–16. Outcomes reported are predominantly on the practice and perception of SDM: In the surgical sphere, SDM is associated with higher patient satisfaction, but clinician and patient perceptions of if it has occurred do not always align; patients with lower socioeconomic status and depression often have worse perceptions of their SDM process.…”