Experienced barriers in shared decision‐making behaviour of orthopaedic surgery residents compared with orthopaedic surgeons

Bossen, Jeroen K. J.; Driessen, Erik; Heyligers, Ide C.

doi:10.1002/msc.1390

Cited by 8 publications

(4 citation statements)

References 34 publications

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“…The reasons for their 'paternalism preference' remain unclear. It has been shown that residents and junior doctors feel uncertain about applying SDM in their encounters with patients [17][18][19], which may contribute to their preference for paternalistic decision making. To our knowledge the relationship between residents' uncertainty and their decision-making behavior in medical encounters has not been studied to date.…”

Section: Introductionmentioning

confidence: 99%

Why do medical residents prefer paternalistic decision making? An interview study

et al. 2022

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Background Although shared decision making is championed as the preferred model for patient care by patient organizations, researchers and medical professionals, its application in daily practice remains limited. We previously showed that residents more often prefer paternalistic decision making than their supervisors. Because both the views of residents on the decision-making process in medical consultations and the reasons for their ‘paternalism preference’ are unknown, this study explored residents’ views on the decision-making process in medical encounters and the factors affecting it. Methods We interviewed 12 residents from various specialties at a large Dutch teaching hospital in 2019–2020, exploring how they involved patients in decisions. All participating residents provided written informed consent. Data analysis occurred concurrently with data collection in an iterative process informing adaptations to the interview topic guide when deemed necessary. Constant comparative analysis was used to develop themes. We ceased data collection when information sufficiency was achieved. Results Participants described how active engagement of patients in discussing options and decision making was influenced by contextual factors (patient characteristics, logistical factors such as available time, and supervisors’ recommendations) and by limitations in their medical and shared decision-making knowledge. The residents’ decision-making behavior appeared strongly affected by their conviction that they are responsible for arriving at the correct diagnosis and providing the best evidence-based treatment. They described shared decision making as the process of patients consenting with physician-recommended treatment or patients choosing their preferred option when no best evidence-based option was available. Conclusions Residents’ decision making appears to be affected by contextual factors, their medical knowledge, their knowledge about SDM, and by their beliefs and convictions about their professional responsibilities as a doctor, ensuring that patients receive the best possible evidence-based treatment. They confuse SDM with acquiring informed consent with the physician’s treatment recommendations and with letting patients decide which treatment they prefer in case no evidence based guideline recommendation is available. Teaching SDM to residents should not only include skills training, but also target residents’ perceptions and convictions regarding their role in the decision-making process in consultations.

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Section: Introductionmentioning

confidence: 99%

Why do medical residents prefer paternalistic decision making? An interview study

et al. 2022

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“…Previous studies indicate that the intention to engage in SDM among physicians varies between settings and disciplines. 26,27 In this study, dermatologists who served at private healthcare settings had higher SDM sore and stimulus score, but had lower barrier score in SDM implementation than those who served at public healthcare settings. The results for institution type are in alignment with the previous studies that the type of care provided by different institutions would influence the extent to which dermatologists and patients actually participate in decision-making.…”

Section: Discussionmentioning

confidence: 58%

Barriers and Stimulus in Shared Decision Making Among Aesthetic Dermatologists in China: Findings from a Cross-Sectional Study

Fan,

Li,

Qiang

et al. 2024

CCID

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Shared decision making (SDM) is a collaborative process involving both healthcare providers and patients in making medical decisions, which gains increasing prominence in healthcare practice. But evidence on the level of SDM in medical practice and barriers as well as stimulus during the SDM implementation among aesthetic dermatologists is limited in China. Methods: From July to August 2023, 1938 dermatologists were recruited online in China. Data were collected through an electronic questionnaire covering: (1) demographic features; (2) SDM questionnaire physician version (SDM-Q-Doc); and (3) stimulus and barriers in SDM implementation. Logistic regression was applied to explore factors associated with SDM practice, barriers, and stimulus of SDM implementation, respectively. Results: The 1938 dermatologists included 1329 females (68.6%), with an average age of 35 years. The total SDM score ranged from 0 to 45, with a median value of 40 (IQR: 35-44), and the median stimulus score and barriers scores were 28 (IQR: 24-32) and 19 (IQR: 13-26), respectively. The prevalence of good SDM was 27.2%, logistic regression indicated that female dermatologists (odds ratio, OR=1.21, 95% confidence interval, CI: 0.96-1.51), and dermatologists with more years of aesthetic practice had a higher proportion of good SDM practice (OR was 1.44 for 5-9 years, 1.58 for 10-15 years and 1.77 for over 15 years). Moreover, female dermatologists and dermatologists with higher education level and serviced in private settings had lower barrier scores; female dermatologists and dermatologists with more years of aesthetic practice had higher stimulus scores. Conclusion: Chinese aesthetic dermatologists appear to implement SDM at an active level, with more stimulus and less barriers in SDM implementation. The integration of SDM into clinical practice among dermatologists is beneficial both for patients and dermatologists. Moreover, SDM practice should be strongly promoted and enhanced during medical aesthetics, especially among male dermatologists, dermatologists with less working experience, and those who work at public institutions.

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“…It has previously been suggested that a non-surgical treatment decision taken by an orthopaedic surgeon is related to greater experience and a less macho attitude towards surgery [ 27 ], yet the present results show that patients and orthopaedic surgeons seem to have different opinions about the decision-making process, in terms of patient involvement. Orthopaedic surgeons are in general willing to be involved in a shared decision-making process [ 28 ], although it is a barrier that they are concerned that it is more time consuming [ 29 ]. Research shows that both healthcare personnel and patients prefer a SDM management [ 30 ], and when they are provided with information about the injury and treatment options, patients are more likely to be involved in their healthcare decisions [ 31 ].…”

Section: Discussionmentioning

confidence: 99%

Treatment decision-making process after an anterior cruciate ligament injury: patients’, orthopaedic surgeons’ and physiotherapists’ perspectives

Grevnerts

Krevers

Kvist

2022

BMC Musculoskelet Disord

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Objective To investigate the treatment decision-making process after an anterior cruciate ligament (ACL) injury from patients’, orthopaedic surgeons’ and physiotherapists’ perspectives. Methods The study is a part of the NACOX study, which is designed to describe the natural corollaries after ACL injury. For the present study, a subgroup 101 patients were included. Patients, their orthopaedic surgeons and their physiotherapists, answered a Shared Decision-Making Process (SDMP) questionnaire, when treatment decision for ACL reconstruction surgery (ACLR) or non-reconstruction (non-ACLR) was taken. The SDMP questionnaire covers four topics: “ informed patient”, “ to be heard”, “ involvement” and “ agreement”. Results Most (75–98%) patients considered their needs met in terms of being heard and agreement with the treatment decision. However, fewer in the non-ACLR group compared to the ACLR group reported satisfaction with information from the orthopaedic surgeon (67% and 79%), or for their own involvement in the treatment decision process (67% and 97%). Conclusion and practice implications Most patients and caregivers considered that patients’ needs to be informed, heard and involved, and to agree with the decision about the treatment process, were fulfilled to a high extent. However, patients where a non-ACLR decision was taken experienced being involved in the treatment decision to a lower extent. This implies that the non-ACLR treatment decision process needs further clarification, especially from the patient involvement perspective.

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Experienced barriers in shared decision‐making behaviour of orthopaedic surgery residents compared with orthopaedic surgeons

Cited by 8 publications

References 34 publications

Why do medical residents prefer paternalistic decision making? An interview study

Why do medical residents prefer paternalistic decision making? An interview study

Barriers and Stimulus in Shared Decision Making Among Aesthetic Dermatologists in China: Findings from a Cross-Sectional Study

Treatment decision-making process after an anterior cruciate ligament injury: patients’, orthopaedic surgeons’ and physiotherapists’ perspectives

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