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Informed Shared Decision Making and Patient Satisfaction
Arjan G.J. Bot, MD; Jeroen K.J. Bossen, BS; James H. Herndon, MD, MBA; David E. Ruchelsman, MD; David C. Ring, MD, PhD; Ana-Maria Vranceanu, PhD;
Massachusetts General Hospital

Introduction: Informed shared decision making (ISDM) is advocated in general orthopaedics, and earlier studies showed a relation with patient satisfaction.The aim of this study was to assess patient satisfaction in relation to the quality of ISDM while controlling for heightened illness concerns, catastrophic thinking and depression.

Materials & Methods: Hundred-thirty patients (52% women, mean age of 52 years) with non-traumatic pain conditions of the upper extremity were analyzed. At enrollment, patients completed: the Princess Margaret Hospital Patient Satisfaction with their Doctor Questionnaire (PMH-PSQ-MD) to measure satisfaction; Disabilities of Arm Shoulder and Hand questionnaire (DASH) to measure arm specific disability; PHQ-9 for symptoms of depression; Whiteley index to assess heightened illness concerns and pain catastrophizing scale (PCS) for catastrophic thinking. Medical encounters were audio recorded to evaluate the 8 ISDM elements and total ISDM. We used bivariate and multivariate analysis to determine predictors of satisfaction, ISDM and arm specific disability.

Results: The mean (±SD) ISDM score was 19 ± 3.6 points. Doctors scored highest on the ISDM element Action plan and lowest on Information preference. Lower Whiteley index, female sex, the ISDM element Identify choice, and any specific diagnosis determined 22% of the variation of PMH-PSQ-MD score. Lower Whiteley and working status were predictors of ISDM; and PCS, PHQ and any specific diagnosis were predictors of DASH.

Conclusions: We found that hand surgeons used ISDM to a moderate level and ISDM is a predictor of satisfaction. Disability is determined by patient factors, not by ISDM. Identify choice was the only element of the ISDM related to satisfaction, indicating the importance of providing patients various treatment options. The importance of ISDM in satisfaction is an argument for the use of decision aids.

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