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Informed, engaged patients have better overall orthopedic care experiences
The study linked shared decision-making with improved patient satisfaction, outcomes.
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Better outcomes and higher patient-satisfaction rates were observed among patients who were well-informed and decided on treatment in conjunction with their orthopedic surgeons, according to study results in The Journal of Bone & Joint Surgery.
“We were really interested in understanding [the patients’] decision making. We think it is really important to do,” Karen Sepucha, PhD, director of Health Decision Sciences Center, Massachusetts General Hospital, told Orthopedics Today. She noted the study’s take-home message about the orthopedic surgery experience is also associated with improvements in health outcomes.
“If we make sure our patients are well-informed, and if we make sure we are listening to them and matching the right treatment to the right patients, they actually do better,” Sepucha said.
Harry E. Rubash, MD, FAOA, chief emeritus, orthopaedic surgery at Massachusetts General Hospital and Edith A. Ashley professor at Harvard Medical School, said, “[The] goal is to increase physician awareness about the powerful impact of these decision aids. We also want to increase awareness in patients — these aids will inform them and help them with the choices that they make in selecting their orthopedic care. Shared decision-making helps everyone: the patient and the health care provider.”
Patients surveyed
Rubash, Sepucha and colleagues prospectively studied 550 patients with knee or hip osteoarthritis, lumbar herniated discs or lumbar spinal stenosis. One week after their first visit with a specialist, patients were sent a survey by mail which evaluated the patients’ knowledge, preferred treatment and baseline quality of life (QoL). Patients were sent another survey that assessed treatment, QoL, regret regarding their treatment choice and satisfaction at 6 months after they underwent either non-surgical or surgical treatment. Investigators used regression analyses to test whether patients who made informed, patient-centered decisions had greater QoL, higher satisfaction and fewer decision regrets at follow-up.
The findings showed response rates of 70.3% for the first survey and 85% for the second survey. Within 6 months of the initial visit, 49% of patients underwent surgery. Rubash, Sepucha and colleagues noted one-third of patients met the informed, patient-centered decision criteria and these patients had significantly greater disease-specific and overall QoL.
Patients in the patient-centered decision group had greater chances of being extremely satisfied with pain relief, being very or extremely satisfied with treatment and with having less regret, the researchers noted.
Keep patients well-informed
The next step in this research is a randomized, comparative effectiveness study to evaluate the different decision aids and decision support tools available to determine which works best for patients.
Massachusetts General Hospital is trying to integrate the use of decision aids with its routine care so that all new patients receive a decision aid prior to their visit with either the surgeon or specialist, Sepucha and Rubash said.
“[The] study was making that connection between shared decision-making and the health outcome,” Sepucha said. “But, we did also find patients were more satisfied with how their treatments turned out, with how their symptoms turned out and they had less regret. They really did feel better and just had a better experience with their care. It is important to figure out how to routinely engage patients and help them to get informed so that they are active participants in their care.”
Reference:
Sepucha K, et al. J Bone Joint Surg Am. 2017;doi:10.2106/JBJS.16.01045.
For more information:
Karen Sepucha, PhD, and Harry E. Rubash, MD, FAOA, can be reached at Massachusetts General Hospital, 55 Fruit St., Boston, MA 02114; Sepucha email: ksepucha@mgh.harvard.edu. Rubash email: hrubash@partners.org.
Disclosures: Rubash reports no relevant financial disclosures. Sepucha reports the study was funded by a grant from the Gordon and Betty Moore Foundation and she receives salary support as a scientific advisory board member for Healthwise.
Perspective
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James D. Slover , MD, MS
The study by Sepucha and her colleagues examined the important issue of medical decision-making in elective orthopedic surgery. It demonstrated that patients who made informed patient-centered decisions, defined as decisions made by patients who retained adequate knowledge of their condition and treatment options at the time of follow-up and who received their preferred treatment, were more likely to be satisfied with their pain and had improved outcome scores. This was compared with patients who did not meet the criteria for an informed patient-centered decision.
Shared decision-making involves the development of treatment strategies by patients and physicians working together that account for the available evidence regarding the different treatment strategies, but also for each individual patient’s preferences and values and how they impact these treatment choices, with the goal of an informed patient-centered decision. The findings from this study demonstrate the potential of shared decision-making in orthopedic practice to not only enhance the patient experience and improve patient satisfaction, but to improve the results of treatment for patients considering elective orthopedic surgery. However, only one third of patients in the study were considered to have made an informed patient-centered decision according to the authors’ criteria. This highlights the challenges going forward of successfully implementing shared decision-making into modern clinical practice. Future work will need to identify strategies to improve this process and to further monitor its impact on both satisfaction and patient outcome, and this study is an important step in that direction.
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