Patient Preferences for Shared Decision Making: Not All Decisions Should Be Shared.

Area of Science:

• Orthopaedic Surgery
• Patient-Centered Care
• Health Psychology

Background:

• Shared decision-making (SDM) is crucial for patient-centered care in orthopaedic surgery.
• Understanding patient preferences for involvement in clinical decisions is essential for effective SDM.
• This study explored patient desires regarding decision-making in musculoskeletal condition management.

Purpose of the Study:

• To determine the extent to which patients wish to participate in decision-making processes for orthopaedic conditions.
• To identify specific clinical decisions where patients prefer more or less involvement.
• To assess factors influencing patient preferences in shared decision-making.

Main Methods:

• An exploratory study surveyed 115 patients at an orthopaedic surgery clinic.
• Patients rated their preferred involvement level (0-10 scale) across 25 theoretical clinical decisions.
• Involvement levels ranged from passive to active, including equally shared decision-making.

Main Results:

• Patients overwhelmingly preferred semipassive roles (92% of decisions).
• Highest desired involvement was in scheduling surgery; lowest was in determining incision size.
• No difference in desired involvement was found between patients with or without prior orthopaedic surgery experience.
• Younger, educated patients desired more involvement; Medicare patients preferred more passive roles.

Conclusions:

• While shared decision-making is valued, patients do not seek to co-decide on all aspects of their orthopaedic care.
• Patient preferences for involvement vary significantly across different types of clinical decisions.
• Tailoring SDM approaches based on patient preferences and decision context is recommended.