Recommendations Regarding Suspected Scaphoid Fractures Are Associated With Patient and Surgeon Comfort With...

Area of Science:

• Orthopedic Surgery
• Medical Decision Making
• Patient Management

Background:

• Variability in managing suspected scaphoid fractures is common.
• Patient and surgeon factors, including tolerance for uncertainty, may contribute to this variability.
• Understanding these factors is crucial for standardizing care.

Purpose of the Study:

• To evaluate the impact of patient and surgeon tolerance for uncertainty on management strategies for suspected scaphoid fractures.
• To identify patient and surgeon factors associated with management choices.
• To determine factors influencing surgeon comfort with patient-led decision-making.

Main Methods:

• A scenario-based survey experiment was conducted with surgeons.
• Surgeons completed the Intolerance of Uncertainty Scale (IUS-12).
• Eight clinical scenarios with randomized patient factors were presented to surgeons, who recommended management and rated comfort with patient decision-making.

Main Results:

• Additional imaging, the most frequent strategy (50%), correlated with higher injury energy, pain intensity, lower patient uncertainty tolerance, and greater patient desire to return to work.
• Lower surgeon comfort with patient-led decisions was linked to higher pain intensity and lower surgeon tolerance for uncertainty.
• Patient and surgeon comfort with uncertainty significantly influenced management recommendations.

Conclusions:

• Reducing variation in suspected scaphoid fracture management requires addressing surgeon tolerance for uncertainty.
• Strategies should consider patient tolerance for uncertainty and symptom intensity.
• Enhancing surgeon comfort with uncertainty and awareness of symptom-pathophysiology discrepancies is key.