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Cast or Nail? Using a Preference-Based Tool for Shared Decision-Making in Pediatric Femoral Shaft Fracture Treatment
Anthony A Catanzano1, Carolyn Hutyra2, Thomas J Risoli3
1Department of Orthopaedic Surgery, Duke University Health System.
Journal of Pediatric Orthopedics
|June 30, 2023
Summary
This study used adaptive conjoint analysis (ACA) to help families choose between casting and flexible intramedullary nails (FIN) for pediatric femoral shaft fractures. The tool aligned patient preferences with treatment decisions, potentially improving satisfaction.
Area of Science:
- Pediatric Orthopedics
- Health Services Research
- Decision Analysis
Background:
- Femoral shaft fractures are common in children aged 2-7 years.
- Treatments like casting and flexible intramedullary nails (FIN) have similar outcomes.
- A shared decision-making process is crucial given equivalent treatment results.
Purpose of the Study:
- To develop and validate a shared decision-making tool using adaptive conjoint analysis (ACA).
- To assess family preferences for pediatric femoral shaft fracture treatments.
- To align treatment choices with individual family situations.
Main Methods:
- An interactive survey with an ACA exercise was created.
- Amazon Mechanical Turk recruited participants simulating the at-risk population.
- Sawtooth Software analyzed treatment attribute preferences and choices.
Main Results:
- 147 (79%) subjects preferred casting, while 39 (21%) preferred FIN.
- The need for secondary surgery was the most important attribute (42.0).
- Preferences varied significantly between casting and FIN choices regarding secondary surgery, complications, school time, caregiver effort, and activity return.
Conclusions:
- The ACA-based decision tool accurately identified and aligned with subjects' treatment preferences.
- This tool has the potential to enhance shared decision-making and family understanding in pediatric fracture treatment.
- Improved decision-making can lead to better patient satisfaction and overall outcomes.
