Patients who have undergone total shoulder arthroplasty prefer greater surgeon involvement in shared decision making

Raji, Yazdan; Strony, John; Moon, Tyler J.; Smith, Kira L.; Sivasundaram, Lakshmanan; Renko, Nellie; Victoroff, Brian N.; Gillespie, Robert J.

doi:10.1016/j.jse.2022.09.016

Cited by 2 publications

(4 citation statements)

References 22 publications

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“… 16 - 18 Shoulder arthroplasty patients may prefer shared decision-making in the preoperative period and greater surgeon-led decision-making about the type of procedure, the device used, and the management of the postoperative period. 8 Focus groups in knee arthroplasty showed that some patients believe implant choice is best left to the surgical team, while others feel they should express their preference. 19 A broad review of decision-making in elective orthopaedics and rheumatology reported that the majority of patients wanted a shared process.…”

Section: Discussionmentioning

confidence: 99%

“… 3 - 5 Qualitative studies in shoulder arthroplasty are limited to questionnaires and an investigation into postoperative telerehabilitation. 6 - 8 Further research into patient decision-making in shoulder arthroplasty may improve the content and format of information that healthcare staff provide to patients, and guide the outcomes that are captured in arthroplasty research.…”

Section: Introductionmentioning

confidence: 99%

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Factors influencing patient decision-making to undergo shoulder arthroplasty

Davies,

Sabharwal,

Reilly

et al. 2024

Bone Jt Open

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AimsShoulder arthroplasty is effective in the management of end-stage glenohumeral joint arthritis. However, it is major surgery and patients must balance multiple factors when considering the procedure. An understanding of patients’ decision-making processes may facilitate greater support of those considering shoulder arthroplasty and inform the outcomes of future research.MethodsParticipants were recruited from waiting lists of three consultant upper limb surgeons across two NHS hospitals. Semi-structured interviews were conducted with 12 participants who were awaiting elective shoulder arthroplasty. Transcribed interviews were analyzed using a grounded theory approach. Systematic coding was performed; initial codes were categorized and further developed into summary narratives through a process of discussion and refinement. Data collection and analyses continued until thematic saturation was reached.ResultsTwo overall categories emerged: the motivations to consider surgery, and the information participants used to inform their decision-making. Motivations were, broadly, the relief of pain and the opportunity to get on with life and regain independence. When participants’ symptoms and restrictions prevented them enjoying life to a sufficient extent, this provided the motivation to proceed with surgery. Younger participants tended to focus on maintaining employment and recreational activities, and older patients were eager to make the most of their remaining lifetime. Participants gathered information from a range of sources and were keen to optimize their recovery where possible. An important factor for participants was whether they trusted their surgeon and were prepared to delegate responsibility for elements of their care.ConclusionRelief of pain and the opportunity to get on with life were the primary reasons to undergo shoulder arthroplasty. Participants highlighted the importance of the patient-surgeon relationship and the need for accurate information in an accessible format which is relevant to people of different ages and functional demands.Cite this article: Bone Jt Open 2024;5(7):543–549.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Factors influencing patient decision-making to undergo shoulder arthroplasty

Davies,

Sabharwal,

Reilly

et al. 2024

Bone Jt Open

View full text Add to dashboard Cite

show abstract

“…There is a wealth of information on clinical decision aids for patients suffering from OA of the lower extremity joint. 15,[17][18][19][20] In the field of shoulder arthroplasty, Raji et al 22 evaluated the overall patient preference for shared decision making following primary total shoulder arthroplasty (eg, preference on surgeon-led vs shared decisionmaking approach). Patients reported to prefer a shared decision-making approach in regard to pre-operative considerations but indicated a significant preference for surgeon-led decision-making approach regarding day of surgery and postoperative care.…”

Section: Discussionmentioning

confidence: 99%

“…[17][18][19][20][21] Use of patient decision aids in the lower extremity is promising, but the information on role of decision aids in shoulder arthroplasty is limited to a study that has examined patient's input after surgery. 22 Considering the importance of patient perspective in assessing appropriateness for shoulder arthroplasty, further assessment of the subject is warranted. The primary purpose of this study was to validate a 5-item appropriateness decision aid that has been developed and validated for hip and knee arthritis 20 in patients with shoulder pathology.…”

Section: Introductionmentioning

confidence: 99%

Assessing Appropriateness for Shoulder Arthroplasty Using a Shared Decision-Making Process

Razmjou

Christakis

Nam

et al. 2023

Journal of Shoulder and Elbow Arthroplasty

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Purpose The primary purpose of this study was to validate an appropriateness decision-aid tool as a part of engaging patients with glenohumeral arthritis in their surgical management. The associations between the final decision to have surgery and patient characteristics were examined. Materials and Methods This was an observational study. The demographics, overall health, patient-specific risk profile, expectations, and health-related quality of life were documented. Visual analog scale and the American Shoulder & Elbow Surgeon (ASES) measured pain and functional disability, respectively. Clinical and imaging examination documented clinical findings and extent of degenerative arthritis and cuff tear arthropathy. Appropriateness for arthroplasty surgery was documented by a 5-item Likert response survey and the final decision was documented as ready, not-ready, and would like to further discuss. Results Eighty patients, 38 women (47.5%), mean age: 72(8) participated in the study. The appropriateness decision aid showed excellent discriminate validity (area under the receiver operating characteristic curve value of 0.93) in differentiating between patients who were “ready” and those who were “not-ready” to have surgery. Gender ( P = 0.037), overall health ( P = .024), strength in external rotation ( P = .002), pain severity ( P = .001), ASES score ( P < .0001), and expectations ( P = .024) were contributing factors to the decision to have surgery. Imaging findings did not play a significant role in the final decision to have surgery. Conclusions A 5-item tool showed excellent validity in differentiating patients who were ready to have surgery versus those who were not. Patient's gender, expectations, strength, and self-reported outcomes were important factors in reaching the final decision.

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Patients who have undergone total shoulder arthroplasty prefer greater surgeon involvement in shared decision making

Cited by 2 publications

References 22 publications

Factors influencing patient decision-making to undergo shoulder arthroplasty

Factors influencing patient decision-making to undergo shoulder arthroplasty

Assessing Appropriateness for Shoulder Arthroplasty Using a Shared Decision-Making Process

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