"Surgery is certainly one good option": quality and time-efficiency of informed decision-making in surgery.

Full Abstract

BACKGROUND:
Informed decision-making has been widely promoted in several medical settings, but little is known about the actual practice in orthopaedic surgery and there are no clear guidelines on how to improve the process in this setting. This study was designed to explore the quality of informed decision-making in orthopaedic practice and to identify excellent time-efficient examples with older patients.

METHODS:
We recruited orthopaedic surgeons, and patients sixty years of age or older, in a Midwestern metropolitan area for a descriptive study performed through the analysis of audiotaped physician-patient interviews. We used a valid and reliable measure to assess the elements of informed decision-making. These included discussions of the nature of the decision, the patient's role, alternatives, pros and cons, and uncertainties; assessment of the patient's understanding and his or her desire to receive input from others; and exploration of the patient's preferences and the impact on the patient's daily life. The audiotapes were scored with regard to whether there was a complete discussion of each informed-decision-making element (an IDM-18 score of 2) or a partial discussion of each element (an IDM-18 score of 1) as well as with a more pragmatic metric (the IDM-Min score), reflecting whether there was any discussion of the patient's role or preference and of the nature of the decision. The visit duration was studied in relation to the extent of the informed decision-making, and excellent time-efficient examples were sought.

RESULTS:
There were 141 informed-decision-making discussions about surgery, including knee and hip replacement as well as wrist/hand, shoulder, and arthroscopic surgery. Surgeons frequently discussed the nature of the decision (92% of the time), alternatives (62%), and risks and benefits (59%); they rarely discussed the patient's role (14%) or assessed the patient's understanding (12%). The IDM-18 scores of the 141 discussions averaged 5.9 (range, 0 to 15; 95% confidence interval, 5.4 to 6.5). Fifty-seven percent of the discussions met the IDM-Min criteria. The median duration of the visits was sixteen minutes; the extent of informed decision-making had only a modest relationship with the visit duration. Time-efficient strategies that were identified included use of scenarios to illustrate distinct choices, encouraging patient input, and addressing primary concerns rather than lengthy recitations of pros and cons.

CONCLUSIONS:
In this study, which we believe is the first to focus on informed decision-making in orthopaedic surgical practice, we found opportunities for improvement but we also found that excellent informed decision-making is feasible and can be accomplished in a time-efficient manner.

Learn Faster Today Improve your study skills

Author information

Author/s: Braddock, Clarence (C); Hudak, Pamela L (PL); Feldman, Jacob J (JJ); Bereknyei, Sylvia (S); Frankel, Richard M (RM); Levinson, Wendy (W);

Affiliation: Stanford University School of Medicine, 251 Campus Drive, MC 5475, Stanford, CA 94305-5475, USA. cbrad(-atsign-)stanford.edu

Grants: R01 AG018781-05 (Agency:United States NIA)

Journal and publication information

Publication Type: Journal Article; Research Support, N.I.H., Extramural

Journal: The Journal of bone and joint surgery. American volume (J Bone Joint Surg Am), published in United States. (Language: eng)

Reference: 2008-Sep; vol 90 (issue 9) : pp 1830-8

Dates: Created 2008/09/02; Completed 2008/09/23;

PMID: 18762641, status: MEDLINE (last retrieval date: 11/6/2008)

Sourced from the National Library of Medicine. Abstract text and other information may be subject to copyright.

External Links for this article (including full text providers, if available):

Click Electronic Full-text Provider Links to see options for finding the electronic full text links to this article. Note there may be a subscription or fee required for access to the full text. See our FAQ for information on finding FREE full text articles.

This article may also be located in paper journal collections available in many libraries. Use the Journal and Publication Information above to find the full article.

MeSH headings (categories)

This article was linked to the MESH Headings shown below.

Informed Consent
Middle Aged
Orthopedics
Patient Participation
Physician's Practice Patterns - statistics & numerical data
Physician-Patient Relations
Quality of Health Care
Questionnaires

These are the highest related articles currently in the database:

See 100+ related articles.