Shared Decision-Making in General Surgery: Prospective Comparison of Telemedicine vs In-Person Visits

Abstract

BACKGROUND: The coronavirus disease 2019 (COVID-19) pandemic has accelerated a shift toward virtual telemedicine appointments with surgeons. While this form of healthcare delivery has potential benefits for both patients and surgeons, the quality of these interactions remains largely unstudied. We hypothesize that telemedicine visits are associated with lower quality of shared decision-making. STUDY DESIGN: We performed a mixed-methods, prospective, observational cohort trial. All patients presenting for a first-time visit at general surgery clinics between May 2021 and June 2022 were included. Patients were categorized by type of visit: in-person vs telemedicine. The primary outcome was the level of shared decision-making as captured by top box scores of the CollaboRATE measure. Secondary outcomes included quality of shared decision-making as captured by the 9-item Shared Decision-Making Questionnaire and satisfaction with consultation survey. An adjusted analysis was performed accounting for potential confounders. A qualitative analysis of open-ended questions for both patients and practitioners was performed. RESULTS: During a 13-month study period, 387 patients were enrolled, of which 301 (77.8%) underwent in-person visits and 86 (22.2%) underwent telemedicine visits. The groups were similar in age, sex, employment, education, and generic quality-of-life scores. In an adjusted analysis, a visit type of telemedicine was not associated with either the CollaboRATE top box score (odds ratio 1.27; 95% CI 0.74 to 2.20) or 9-item Shared Decision-Making Questionnaire (β −0.60; p = 0.76). Similarly, there was no difference in other outcomes. Themes from qualitative patient and surgeon responses included physical presence, time investment, appropriateness for visit purpose, technical difficulties, and communication quality CONCLUSIONS: In this large, prospective study, there does not appear to be a difference in quality of shared decision making in patients undergoing in-person vs telemedicine appointments.

Exploring differences in patient participation in simulated emergency cases in co-located and distributed rural emergency teams – an observational study with a randomized cross-over design

“…Delivering patient-centered care, which includes patient participation and shared decision-making, is a highly valued competency for all healthcare professionals [ 10 , 11 ]. While shared decision-making in ‘virtual’ appointments has been shown to be comparable to in-person visits in other areas of healthcare [ 1 , 26 ], literature on shared decision-making in an emergency care team context involving telemedicine is missing. In this study, we observed low levels of ‘sharing power’, including shared decision-making, in both settings.…”

Completion of Recommended Tests and Referrals in Telehealth vs In-Person Visits

“…After the visit, patients do not receive any communication reminding them to schedule the test or referral, which may further limit loop closure. Other potential explanations include the possibility that it may be more difficult to remember information provided during telehealth visits, that telehealth may present unique communication barriers, or that it may be more difficult to engage patients in shared decision-making during virtual visits, thus decreasing patient engagement with test and referral orders …”

“…Other potential explanations include the possibility that it may be more difficult to remember information provided during telehealth visits, that telehealth may present unique communication barriers, or that it may be more difficult to engage patients in shared decision-making during virtual visits, thus decreasing patient engagement with test and referral orders. [18][19][20][21] These barriers may be more pronounced for colonoscopies compared with other types of orders given the increased difficulty in preparing for and completing the invasive procedure, thus explaining the disparities in loop closure compared with the other orders included in our analysis. 22 Furthermore, given the notable difference in loop closure for colonoscopies, telehealth visits may serve as a marker for patients not participating in a high-complexity test.…”

Shared Decision‐Making During Virtual Care Regarding Rheumatologic and Chronic Conditions: Qualitative Study of Benefits, Pitfalls, and Optimization

“…Virtual care (VC) takes place whenever technology facilitates care delivery 9 . VC sometimes can promote SDM; for example, surgery patients reported equivalent quality of SDM during VC versus in‐person visits 10 . Unfortunately, other accounts demonstrate challenges.…”

“… 9 VC sometimes can promote SDM; for example, surgery patients reported equivalent quality of SDM during VC versus in‐person visits. 10 Unfortunately, other accounts demonstrate challenges. Patients with RCCs stated that they “lost their voice” when VC emerged, and analyses of teleconsultations among primary care providers, specialists, and patients showed reduced patient participation.…”