Shared Decision-making in Orthopaedic Surgery

Wilson, Charlie D.; Probe, Robert A.

doi:10.5435/jaaos-d-20-00556

Cited by 27 publications

(23 citation statements)

References 40 publications

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“…In our clinical practice, we have found that shared decision-making and decision-aid tools assist in eliciting patients' preferences, goals, and functional status, which is then used to make a treatment decision that aligns with their preferences, goals, and functional demands. 6,7,19 Because strong evidence suggests that no difference in radiographic or patient-reported outcomes exist based on fixation technique for complete articular or unstable distal radius fractures (after 3 months), we advocate for the use of a fixation technique driven by the fracture pattern and patient characteristics. In the illustrated case, we felt a volar approach and volar locking plate would allow adequate visualization and capture and neutralize forces as a fixed-angle construct by transmitting forces from the distal fragments to the radial shaft.…”

Section: Discussionmentioning

confidence: 99%

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Practical Application of the 2020 Distal Radius Fracture AAOS/ASSH Clinical Practice Guideline: A Clinical Case

Kamal

Shapiro

2023

J Am Acad Orthop Surg

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The Clinical Practice Guideline Management of Distal Radius Fractures released by the American Academy of Orthopaedic Surgeons and the American Society for Surgery of the Hand is a summary of the available evidence designed to guide surgeons and other qualified physicians in the management of distal radius fractures. According to this guideline, age of 65 is used as a proxy for functional activity and can serve as a threshold under which patients are likely to benefit from surgical fixation and over which patients are less likely to benefit from surgical fixation when compared with nonsurgical treatment. Supervised therapy and arthroscopic assistance should be used sparingly and on a case-by-case basis. Routine radiographs should also be used on a case-by-case basis. As strong evidence suggests no difference observed in clinical or radiographic outcomes by fixation technique used after 3 months, fixation technique should be driven by fracture pattern. These guidelines serve to guide physicians in the care of patients with distal radius fractures.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Practical Application of the 2020 Distal Radius Fracture AAOS/ASSH Clinical Practice Guideline: A Clinical Case

Kamal

Shapiro

2023

J Am Acad Orthop Surg

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“…Physicians at our institution particularly utilize PROM data in clinical encounters to discuss progress following surgical procedures or nonoperative treatments. Therefore, any and all attempts at improving their integration may yield benefits for improved patient care 24 . There have been numerous studies that have demonstrated the utility of incorporating PROMs in this fashion [25][26][27] .…”

Section: Discussionmentioning

confidence: 99%

Pre-Visit Digital Messaging Improves Patient-Reported Outcome Measure Participation Prior to the Orthopaedic Ambulatory Visit

Yedulla

Hester

Patel

et al. 2022

Journal of Bone and Joint Surgery

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Background: Patient-reported outcome measures (PROMs) are metrics that assess physical health, mental health, pain, and satisfaction. However, PROM collection in orthopaedic clinics presents numerous logistical and financial challenges. These challenges are reduced when PROMs are completed before clinic encounters, relieving the workflow constraints of in-office PROM collection. The purpose of this study was to determine the efficacy of 3 different methods with respect to pre-visit electronic PROM completion.Methods: Consecutive adult orthopaedic patients with no previous PROM participation were enrolled. Patients who registered with the electronic medical record (EMR) patient portal (MyChart) and with active e-mail addresses were randomly assigned to 1 of 3 arms: control (no pre-visit messages), MyChart (EMR patient portal pre-visit messages), and email (e-mail pre-visit messages). The primary outcome measure was pre-visit PROM completion rates in orthopaedic patients, and the secondary outcome measures were time to pre-visit PROM form completion and PROM form completion rates according to patient demographic characteristics. By default, the Patient-Reported Outcomes Measurement Information System (PROMIS) forms were available for completion through the portal by 7 days before scheduled visits. Previsit messages were sent 7 days prior to the scheduled visit except in the control group, with reminders sent 3 days prior if still not completed. The patients in each arm who completed all assigned forms were labeled as having total PROM completion, and those who completed at least 1 completed form were considered as having partial PROM completion. Multivariable logistic regression models were used to assess differences in PROM completion rates between study arms. Kruskal-Wallis tests were performed to compare the date of the form completion.Results: A total of 291 patients were included. The pre-visit total completion rates for assigned PROMs were higher in the MyChart arm (49% of 97 patients; p = 0.005) and the e-mail arm (52% of 100 patients; p = 0.002) in comparison with the control arm (30% of 94 patients). Male patients were more likely than female patients to have partial pre-visit PROM completion (odds ratio [OR], 1.74; p = 0.03), and Caucasian patients were more likely to have partial pre-visit PROM completion than African American patients (OR, 2.28; p = 0.01).Conclusions: Orthopaedic patients receiving either e-mail or patient portal messages demonstrated higher pre-visit PROM completion rates. Pre-visit messaging appears to be a useful strategy for increasing PROM completion rates and limiting the clinical workflow strain imposed by in-clinic PROM administration.

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“…Another concept this study raises [5] is the use of a shared decision-making model for decisions regarding surgery in patients with articular fractures of the knee. In shared decision-making, a decision should be shared with patients rather than made for them [6]. It seems clear from this study that not all patients with tibial plateau fractures will benefit from surgical fixation.…”

Section: Where Do We Need To Go?mentioning

confidence: 99%

CORR Insights®: Functional Outcome After Nonoperative Management of Tibial Plateau Fractures in Skeletally Mature Patients: What Sizes of Gaps and Stepoffs Can be Accepted?

Cannada

2022

Clin Orthop Relat Res

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The author certifies that there are no funding or commercial associations (consultancies, stock ownership, equity interest, patent/licensing arrangements, etc.) that might pose a conflict of interest in connection with the submitted article related to the author or any immediate family members. All ICMJE Conflict of Interest Forms for authors and Clinical Orthopaedics and Related Research ® editors and board members are on file with the publication and can be viewed on request. The opinions expressed are those of the writer, and do not reflect the opinion or policy of CORR ® or The Association of Bone and Joint Surgeons ® .

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Shared Decision-making in Orthopaedic Surgery

Cited by 27 publications

References 40 publications

Practical Application of the 2020 Distal Radius Fracture AAOS/ASSH Clinical Practice Guideline: A Clinical Case

Practical Application of the 2020 Distal Radius Fracture AAOS/ASSH Clinical Practice Guideline: A Clinical Case

Pre-Visit Digital Messaging Improves Patient-Reported Outcome Measure Participation Prior to the Orthopaedic Ambulatory Visit

CORR Insights®: Functional Outcome After Nonoperative Management of Tibial Plateau Fractures in Skeletally Mature Patients: What Sizes of Gaps and Stepoffs Can be Accepted?

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