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

Abstract

Aims: In a scenario-based survey experiment, we evaluated the contributions of patient and surgeon tolerance for uncertainty to variation in management strategies for suspected scaphoid fractures. We asked the following: (1) Are patient and surgeon factors, including comfort with uncertainty, associated with the choice of management strategy for a suspected scaphoid fracture? and (2) What patient and surgeon factors are associated with comfort letting the patient decide how to manage their suspected scaphoid fracture?

Methods: Surgeon members of the Science of Variation Group completed the short-form Intolerance of Uncertainty Scale (IUS-12) and then reviewed eight clinical scenarios of patients with suspected scaphoid fractures with the following aspects randomized: pain intensity, mechanism of injury, patient's motivation to return to activities, willingness to accept risks, and confidence in decision making. Surgeons were asked to indicate their recommended management strategy and rated their comfort with letting the patient decide.

Results: Surgeon recommendation of additional imaging (the most popular strategy; 50%) was associated with higher energy of injury, greater pain intensity, lower patient comfort with uncertainty, and greater desire to go back to work. Lower comfort with allowing the patient to choose the management strategy was associated with higher pain intensity and lower surgeon tolerance of uncertainty.

Conclusion: This study suggests that efforts to reduce variation in the management of suspected scaphoid fractures can address variations in surgeon tolerance of uncertainty and surgeon regard for variations in symptom intensity and patient tolerance of uncertainty.

Clinical relevance: Strategies for the management of suspected scaphoid fracture can be designed to increase surgeon comfort with the unavoidable uncertainty associated with management of suspected scaphoid fractures, and surgeon awareness of the limited correspondence between symptom intensity and pathophysiology severity.