How Much Do Patients Want to Be Involved in Orthopedic Decision Making?

As treatment options for various conditions expand, patients are sometimes given choices when it comes to how they wish to manage their conditions. Researchers recently explored just how much patients want to take part in decision making when it comes to musculoskeletal conditions and found that it depends on the choice in question.

“Shared decision making (SDM) is thought to be the preferred method of decision making when patients are faced with treatment equipoise. SDM increases patient involvement in decision making and also leads to improved knowledge of the options available, and a feeling of empowerment to be more active in the decision-making process,” the study authors reported in the Journal of the AAOS.

The study included patients seeking care at a multispecialty orthopedic surgery clinic with subspecialties of trauma, tumor, foot and ankle, sports, spine, and hand/upper extremity between July 2017 and January 2018 who had recently undergone orthopedic surgery (postoperative) or who had not (preoperative). Patients rated each decision on a 10-point scale, on which 0 indicated no patient involvement (fully passive), 1 to 4 indicated a semipassive role, 5 indicated equally shared involvement between patient and surgeon, 6 to 9 indicated a semiactive role, and 10 indicated no surgeon involvement (fully active).

Decision Making Depends on the Decision

Final analysis included 115 patients (mean age, 55.9 years; 51.8% were female). Regarding preoperative choices, patients wanted to take a semipassive role in 89% of decisions assessed wanted to share 11% of the decisions. Regarding intraoperative decisions, on average, patients preferred to take a semipassive role in all choices. For postoperative choices, patients wanted to take a semipassive role in 91% and a shared role in 9% of them. Outcomes did not differ between pre- and postoperative patients. Younger age and having at least a college education were associated with wanting a semipassive role in more than 50% of decisions. Patients on Medicare insurance preferred a passive role in more than half of choices.

The researchers explained that patients seemed to have specific preferences regarding when they wanted to be involved in decision making and said that implementing SDM would perhaps be most advantageous if focused on the specific choices important to patients. In this study, for example, patients did not want to take an active role in choosing which suture to use to close an incision, deferring to the surgeon.

“The evidence supporting SDM in delivering high-quality, patient-centered care continues to grow. The results of our study reiterate this importance and highlights that patients have preferences for which decisions are shared. As health policy continues to emphasize engaging patients in SDM, understanding which decisions are most important to a patient helps prioritize and direct SDM efforts toward specific aspects of care,” the study authors concluded.