Purpose
Interventions that improve a patient’s understanding of the problem and their options
might reduce surgeon-to-surgeon variation, activate healthier patient behaviors and
mindset, and optimize stewardship of resources while improving quality of care. Patients
with carpal tunnel syndrome (CTS) have more uncertainty about which course of action
to take (so-called decision conflict) than hand surgeons. We studied patient preferences
regarding shared decision making (SDM) for different parts of the treatment for CTS.
We assessed the following hypotheses: (1) Younger age does not correlate with a preference
for greater involvement in decisions; (2) Demographic and socioeconomic factors are
not independently associated with (A) preferences for decision making (separated into
preoperative, operative, postoperative, and the full SDM scale) and (B) the Control
Preference Scale; (3) the SDM scale does not correlate with the Control Preference
Scale.
Methods
We prospectively invited 113 new and postoperative patients with CTS to participate
in the study. We recorded their demographics and they completed the SDM scale and
the Control Preference Scale.
Results
The full SDM scale and all subsets showed a patient preference toward sharing the
decisions for treatment with the surgeon with a moderate tendency toward patients
wanting more surgeon involvement in decision making. On multivariable analysis, having
commercial insurance compared with Medicare was independently associated with a preference
for less surgeon involvement (ie, higher SDM scores) in decision making (regression
coefficient, 0.60; 95% confidence interval, 0.03–1.2).
Conclusions
Patients with CTS generally prefer to share decisions with their surgeon with a tendency
for more surgeon involvement especially in the operative and postoperative period.
Clinical relevance
Decision aids and preference elicitation tools used to ensure diagnostic and treatment
decisions for CTS that are aligned with patient preferences are needed. Future studies
might address the routine use of these tools on patient outcomes.
Key words
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Article info
Publication history
Published online: September 17, 2019
Accepted:
August 2,
2019
Received:
January 6,
2019
Footnotes
No benefits in any form have been received or will be received related directly or indirectly to the subject of this article.
This study received approval from the Institutional Review Board of the University of Texas at Austin. This study has been performed in accordance with the ethical standards in the 1964 Declaration of Helsinki. This study has been carried out in accordance with relevant regulations of HIPAA.
Identification
Copyright
© 2019 by the American Society for Surgery of the Hand. All rights reserved.
