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Evaluating Shared Decision-Making in Treatment Selection for Dupuytren Contracture: A Mixed Methods Approach.

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Patients with Dupuytren contracture value shared decision-making in treatment selection. Preferences for long-term results, recovery, and convenience influence choices between surgical and nonsurgical options.

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Area of Science:

  • Orthopedics
  • Hand Surgery
  • Patient-Centered Care

Background:

  • Dupuytren contracture presents diverse treatment options.
  • Patient involvement in shared decision-making for Dupuytren contracture treatment remains under-explored.

Purpose of the Study:

  • To investigate patient experiences and decision-making processes in selecting treatments for Dupuytren contracture.
  • To assess the level of shared decision-making and patient satisfaction across different treatment modalities.

Main Methods:

  • An explanatory-sequential mixed-methods study design.
  • Quantitative data collected via the Nine-Item Shared Decision-Making Questionnaire and brief Michigan Hand Outcomes Questionnaire.
  • Qualitative data gathered through semi-structured interviews exploring treatment selection experiences.

Main Results:

  • Thirty participants (83% male, mean age 69) underwent collagenase injection, needle aponeurotomy, or limited fasciectomy.
  • High scores on shared decision-making (71) and satisfaction (77) questionnaires were observed.
  • Treatment choices were driven by preferences for long-term solutions (fasciectomy) versus convenience and rapid return to activities (injection, aponeurotomy).

Conclusions:

  • Physician guidance should align treatments with patient priorities regarding outcomes, recovery, and risks.
  • Enhancing shared decision-making requires balanced presentation of all treatments and realistic expectation setting regarding Dupuytren contracture's chronic nature.