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. 2020 Dec 4;8(12):2325967120966145.
doi: 10.1177/2325967120966145. eCollection 2020 Dec.

Surgeon Applications of Patient Preferences in Treatment Decision Making for First-Time Anterior Shoulder Dislocation

Brian C Lau  1 , Carolyn A Hutyra  2 , Benjamin Streufert  3 , Shelby D Reed  4 , Lori A Orlando  5 , Joel C Huber  6 , Dean C Taylor  1 , Richard C Mather 3rd  1
Affiliations

Surgeon Applications of Patient Preferences in Treatment Decision Making for First-Time Anterior Shoulder Dislocation

Brian C Lau et al. Orthop J Sports Med. .

Abstract

Background: Treatment of a first-time anterior shoulder dislocation (FTASD) is sensitive to patient preferences. The operative or nonoperative management debate provides an excellent opportunity to learn how surgeons apply patient preferences in treatment decisions.

Purpose: To determine how patient preferences (repeat dislocation risk, recovery difficulties, fear of surgery, treatment costs) and surgeon factors influence a surgeon's treatment plan for FTASD.

Study design: Cross-sectional study.

Methods: Eight clinical vignettes of hypothetical patients with FTASD (including age, sex, and activity level) were presented to members of the Magellan Society. A second set of matched vignettes with patient preferences and clinical variables were also presented. The vignettes represented scenarios in which evidence does not favor one treatment over another. Respondents were asked how they would manage each hypothetical case. Respondents also estimated the risk of redislocation for the nonoperative cases for comparison with the published rates. Finally, respondents completed a Likert-scale questionnaire to determine their perceptions on factors influencing their decisions.

Results: A total of 103 orthopaedic surgeons completed the survey; 48% practiced in an academic hospital; 79% were in practice for 10 years or longer; and 75% had completed a sports medicine fellowship. Patient preferences were the single most important factor influencing treatment recommendation, with activity type and age also important. Just 62% of the surgeon estimates of the risk of redislocation were consistent with the published rates. The inclusion of patient preferences to clinical variables changed treatment recommendations in 62.5% of our hypothetical cases. Respondents rated patient treatment preference as the leading factor in their treatment decision making.

Conclusion: Patient preferences were important when deciding the appropriate treatment for FTASD. Respondents were inconsistent when applying evidence in their decision making and estimates of recurrent instability. Decision support tools that deliver patient preferences and personalized evidence-based outcome estimates improve the quality of decision making at the point of care.

Keywords: decision analysis; first-time shoulder dislocation; patient preferences; shoulder instability.

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Conflict of interest statement

One or more of the authors has declared the following potential conflict of interest or source of funding: B.C.L. has received educational support from Smith & Nephew and SouthTech Orthopedics and research support from Arthrex. B.S. has received educational support from MVP Orthopedics. D.C.T. has received consulting fees and royalties from DePuy/Medical Device Business Services. R.C.M. has received consulting fees from Stryker and hospitality payments from DJO, RTI, and Trice Medical. AOSSM checks author disclosures against the Open Payments Database (OPD). AOSSM has not conducted an independent investigation on the OPD and disclaims any liability or responsibility relating thereto.

References

    1. Brophy RH, Marx RG. The treatment of traumatic anterior instability of the shoulder: nonoperative and surgical treatment. Arthroscopy. 2009;25(3):298–304. - PubMed
    1. Gill TJ, Micheli LJ, Gebhard F, Binder C. Bankart repair for anterior instability of the shoulder. Long-term outcome. J Bone Joint Surg Am. 1997;79(6):850–857. - PubMed
    1. Harris PA, Taylor R, Thielke R, Payne J, Gonzalez N, Conde JG. Research electronic data capture (REDCap)—a metadata-driven methodology and workflow process for providing translational research informatics support. J Biomed Inform. 2009;42(2):377–381. - PMC - PubMed
    1. Hovelius L, Saeboe M. Neer Award 2008: arthropathy after primary anterior shoulder dislocation—223 shoulders prospectively followed up for twenty-five years. J Shoulder Elbow Surg. 2009;18(3):339–347. - PubMed
    1. Hutyra CA, Smiley S, Taylor DC, Orlando LA, Mather RC., 3rd Efficacy of a preference-based decision tool on treatment decisions for a first-time anterior shoulder dislocation: a randomized controlled trial of at-risk patients. Med Decis Making. 2019;39(3):253–263. - PubMed

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