Do Patient Preferences Influence Surgeon Recommendations for Treatment?

Area of Science:

• Orthopedic Surgery
• Patient-Centered Care
• Medical Decision-Making

Background:

• Patient preferences should guide treatment when options are uncertain.
• Surgeon variability in hand and upper extremity treatment suggests surgeon preferences dominate patient input.

Purpose of the Study:

• To quantify the influence of specific patient preferences on surgeon treatment recommendations.
• To compare the impact of patient versus surgeon preferences in discretionary surgical cases.

Main Methods:

• 184 surgeons evaluated 18 fictional upper extremity scenarios.
• Surgeons recommended operative or non-operative treatment.
• Six patient preferences were randomly assigned to scenarios to test their influence.

Main Results:

• Four of six patient preferences significantly influenced surgeon recommendations.
• Surgeons favored non-operative treatment when patients preferred lower cost or non-operative care.
• Patient concerns about aesthetics and need for surgical consensus also impacted recommendations.

Conclusions:

• Patient preferences measurably influence surgeon recommendations, but less than anticipated.
• Surgeons may perceive surgery as more aesthetic than patients do.
• Decision aids can help patients align values with preferences for shared decision-making.