Shared Decision-making in Orthopaedic Surgery

Abstract

Background The process of clinical decision-making and the patient-physician relationship continue to evolve. Increasing patient involvement in clinical decision-making is embodied in the concept of ''shared decision-making'' (SDM), in which the patient and physician share responsibility in the clinical decision-making process. Various patients' decision aid tools have been developed to enhance this process. Questions/purposes We therefore (1) describe decisionmaking models; (2) discuss the different types of patients' decision aids available to practice SDM; and (3) describe the practice and early impact of SDM on clinical orthopaedic surgery. Methods We performed a search of the literature using PubMed/MEDLINE and Cochrane Library. We identified studies related to shared decision-making and the use of patients' decision aids in orthopaedics. The search resulted in 113 titles, of which 21 were included with seven studies on patients' decision aid use specifically in orthopaedics.Results Although limited studies suggest the use of patients' decision aids may enhance decision-making, conclusions about the use of these aids in orthopaedic clinical practice cannot be made and further research examining the best type, timing, and content of patients' decision aids that will lead to maximum patient involvement and knowledge gains with minimal clinical workflow interruption are needed. Conclusion In clinical practice today, patients are increasingly involved in clinical decision-making. Further research on SDM in orthopaedic surgery examining the feasibility and impact on practice, on patients' willingness and ability to actively participate in shared decision-making, and the timing and type of patients' decision aids appropriate for use is still needed.

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

“…One might also assume that older patients prefer a more paternalistic style and that patients with greater stress, distress, and less effective coping strategies will be more passive. This study in combination with prior studies demonstrate that shared decision-making is preferred by both trauma and nontrauma patients without obvious differences between those two groups of patients [13,21,25]. Patients, regardless of their level of education, deserve to participate in shared decision-making, but to give less-well-educated patients the confidence to do so, appropriate tools need to be developed.…”

The Potential Influence of Regionalization Strategies on Delivery of Care for Elective Total Joint Arthroplasty

“…Investigations into existing health care disparities indicate that patient beliefs and attitudes towards TJA contribute greatly to underutilization [25][26][27]. Policy that overlooks, rather than addressing, these patient-centered characteristics is contrary to recent emphasis on shared decision-making [28] and may exacerbate disparities, as patients may utilize low volume centers (if available) [29] or may continue nonoperative treatment [9].…”

The Impact of Screening, Medical Treatment and Invasive Interventions on Patients' Medical Decision-Making Styles: A Cross-Sectional Study with Inferences to the United States Population

“…In fact, most patients in the joint surgery group described an informed decision-making process in which patients independently deliberated and made a treatment decision, while the individual physicians focused on providing education regarding treatment options [14]. Reasons for the limited use of shared decision making include scarce familiarity and training among surgeons, cost and logistical challenges related to the implementation of shared decision-making programs, and a limited comparative-effectiveness research base available for developing shared decision aids [14,15]. Another possibility is that surgeons have liability concerns due to procedural risks [16].…”

“…However, the use of informed decision making is controversial for conditions patients perceive as high risk. The controversy occurs because decision-making is often a complicated process, perhaps incompatible with a health literacy level frequently achievable by most patients [14,19]. Furthermore, poor patient decisions might occur in response to stress, time pressure, unrealistic expectations, extreme risk aversion, problems in the doctor-patient relationship, as well as lowquality health information obtained from friends, family, media, and the Internet [19,20].…”