Including patients in the decision-making process actually improves outcomes, shows a study presented at the 2017 annual meeting of the American Academy of Orthopaedic Surgeons (AAOS) in San Diego this week.
Patients who were actively involved in discussions with their physician about their course of treatment said they were “extremely satisfied” with their pain (76.68%), they were more likely to be very satisfied or extremely satisfied with treatment (70.68%), and had less regret (5.2% vs. 15.0% p=0.0006).
The study was done by survey of 551 patients with knee or hip osteoarthritis, lumbar herniated disc, or lumbar spinal stenosis.
“Shared decision making in elective surgery decisions is important ethically, and evidence from this study suggests that well-informed patients who receive their preferred treatment have higher satisfaction and small improvements in health outcomes,” the authors of the presentation stated.
The patients were surveyed by mail one week after an initial visit with a specialist. A baseline quality of life assessment was taken and patients were asked about their knowledge of their condition and preferred treatment. A follow-up survey was taken six months later for patients who had surgical and non-surgical treatments. Patients with a passing knowledge score of 60% or higher who received their preferred treatment (either surgery or nonsurgical) were considered to have made an informed, patient-centered decision.
The researchers adjusted for surgery, age, gender, joint and baseline quality of life to test the hypothesis that patients who made informed, patient-centered decisions would have higher quality of life, higher satisfaction, and less decision regret at follow up.
The initial survey was sent to 926 patients of which 652 (70.3%) responded. The follow-up survey was sent to 648 patients with 551 (85%) responding. The patients were on average 63.9 years old, 52.8% female and 92.4% white. With 551 surveys, the study had more than 80% power to detect a difference of 0.05 on the EQ-5D between those who made informed, patient-centered decisions or not.
About half of the participants had surgery (49.0%) within the six months of the visit. One-third (36.0%) met the criteria for informed, patient-centered decisions, and patients who made informed, patient-centered decisions had significantly better overall and disease-specific quality of life, across all topics.
Participants who made informed, patient-centered decisions were more likely to be extremely satisfied with their pain (76.68% vs. 41.86%), more likely to be very or extremely satisfied with treatment (70.68% vs. 34.66%), and had less regret (5.2% vs. 15.0% p=0.0006).
Clinical guidelines encourage shared decision making for elective surgeries, with the goal of ensuring that patients are well-informed and received their preferred treatment, the authors wrote.
Karen Sepucha, Andrew A Freiberg, , Mahima Mangla, Henrik Malchau, Harry E Rubash, Thomas D Cha all of Massachusetts General Hospital. “Shared Decision Making in Orthopaedic Care Leads to Better Health Outcomes: A Prospective Cohort Study,” 2017 annual meeting of the American Academy of Orthopaedic Surgeons (AAOS) in San Diego. March 14, 2017.