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Tool impacts treatment decisions for first-time anterior shoulder dislocations
Participants who received intervention with the decision tool were more likely to choose operative treatment.
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An interactive, preference-based decision tool had a greater impact on decision-making for treatment of first-time anterior shoulder dislocations than standard-of-care information, according to a presenter at a meeting.
“Our study demonstrates that measurement and communication of individual preferences to patients regarding the risks and benefits of treatment for a first-time anterior shoulder dislocation has an impact on decision-making and appears to align decisions with the current evidence,” Richard C. Mather III, MD, of the department of orthopaedic surgery at Duke University School of Medicine, told Orthopedics Today. “Furthermore, the study showed the tool had high acceptability and value to respondents. We were surprised by the number of respondents who were unsure about their decision in the preference-based decision tool group relative to the control. We hypothesize this represents active, deeper thought about the treatment decision given that the preference-based decision tool is active, rather than passive like the control.”
Tool provides personalized evidence
Mather and his colleagues developed an interactive preference-based decision tool to use for treatment decisions in first-time anterior shoulder dislocations. The tool can elicit patient preferences and deliver personalized evidence for treatment of first-time anterior shoulder dislocations.
The 200 study participants were randomized so 100 participants received a text-based control on shoulder dislocations and treatment and 100 participants received the interactive decision tool. The participants’ preference for treatment was the primary outcome. Other outcomes included the decisional conflict scale, stage of decision-making, patient activation and engagement, awareness of preference-sensitive decisions and knowledge retention.
Operative vs nonoperative treatment
At the meeting, Mather said 26% of patients who received the control chose operative treatment whereas 64% of those patients chose nonoperative treatment. Exposure to the preference-based decision tool was the only predictor for the treatment choice.
Participants who completed the intervention were more likely to choose operative treatment and participants who completed the text-based control were more likely to choose nonoperative treatment. Compared with the control, men who received an intervention chose their recommended treatment significantly quicker, according to the results.
In addition, there were no significant differences between the control and the intervention group with regard to secondary outcomes apart from a few subscales from the decisional conflict scale.
Each of the attributes studied had similar weight in the nonoperative group, Mather said during his presentation.
“If you look at the operative and unsure groups, they have about the same preference profile with a strong preference toward avoiding another dislocation. This suggests the unsure group is likely to prefer surgery and also highlights the need to have physician-patient interaction to sort through that,” Mather said. – by Monica Jaramillo
Reference:
Hutyra CA, et al. Paper 2. Presented at: American Shoulder and Elbow Surgeons Specialty Day; March 10, 2018; New Orleans.
For more information:
Richard C. Mather III, MD, can be reached at 4709 Creekstone Drive, Suite 200, Durham, NC 27703; email: mathe016@duke.edu.
Disclosure: Mather reports he is a board/committee member of Arthroscopy Association of North America and North Carolina Orthopaedic Association; is a paid consultant for KNG Health Counseling and Stryker; and receives research support from Reflexion Health and Zimmer Biomet.