Shared Orthopedic Decision Making Resulted in Better Outcomes, Higher Patient Satisfaction

Research presented at the 2017 Annual Meeting of the American Academy of Orthopaedic Surgeons indicated that informed patients who engaged in shared decision making with their clinicians had better treatment outcomes and were more satisfied with their experience.

According to the study abstract, the researchers administered initial and follow-up surveys to 551 patients with orthopedic conditions like hip or knee osteoarthritis, lumbar herniated disc, or lumbar spinal stenosis. The initial survey, sent a week after their first visit with an orthopedic specialist, asked about their preferred treatment, baseline quality of life, and level of knowledge about their condition. Six months after the appointment or surgery, the participants completed a follow-up survey about their treatment choice, current quality of life, regret or satisfaction with their choice, and treatment outcomes.

“We are committed to improving outcomes after surgical procedures,” co-author Harry Rubash, MD, of Massachusetts General Hospital and Harvard Medical School, said in a press statement. “This study found that surgical patients, who are more informed and have a clear preference for surgery, have better outcomes. It highlights the need to focus further on decision making prior to elective surgeries and other treatments.”

Almost half of the patients had surgery within 6 months of the initial visit. The participants were 53% female and 92% white, with an average age of 63.9 years. Nearly two-thirds were college graduates.

Patients’ decisions were classified as informed and patient centered if they had scored 60% or higher on the knowledge test and received their preferred treatment of either surgery or a nonsurgical option. After controlling for variables like surgery, age, gender, and baseline quality of life, the researchers found that the 36% of patients in the study who made informed, patient-centered decisions scored significantly higher on overall and disease-specific measures of quality of life in follow-up surveys than the participants who had not played a role in their treatment decisions. For instance, their mean score on the Oswestry Disability Index was 7.59 points lower than that of their counterparts.

Those who had made shared decisions were also more likely than the other participants to state at follow-up that they were extremely satisfied with their pain level (77% vs 42%) and very or extremely satisfied with their treatment (71% vs 35%). A striking difference was observed in levels of regret, as just 5.2% of the patients who made informed, patient-centered decisions reported regret with their treatment, compared with 15% of those who had not made such decisions.

The study authors explained that these findings demonstrated the value of informed decision making that takes patient choices into account.

“This study is unique in its evaluation of the implementation of a shared decision making process as part of a real world orthopaedic elective surgical practice,” said co-author Thomas Cha, MD, MBA, of the Orthopaedic Spine Center at Massachusetts General Hospital and Harvard Medical School. “Shared decision making did not just result in better patient experience ratings, but also improved patient outcomes.”