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Shared Decision-making in Orthopaedic Surgery

  • Symposium: Value Based Healthcare
  • Published:
Clinical Orthopaedics and Related Research®

Abstract

Background

The process of clinical decision-making and the patient-physician relationship continue to evolve. Increasing patient involvement in clinical decision-making is embodied in the concept of “shared decision-making” (SDM), in which the patient and physician share responsibility in the clinical decision-making process. Various patients’ decision aid tools have been developed to enhance this process.

Questions/purposes

We therefore (1) describe decision-making models; (2) discuss the different types of patients’ decision aids available to practice SDM; and (3) describe the practice and early impact of SDM on clinical orthopaedic surgery.

Methods

We performed a search of the literature using PubMed/MEDLINE and Cochrane Library. We identified studies related to shared decision-making and the use of patients’ decision aids in orthopaedics. The search resulted in 113 titles, of which 21 were included with seven studies on patients’ decision aid use specifically in orthopaedics.

Results

Although limited studies suggest the use of patients’ decision aids may enhance decision-making, conclusions about the use of these aids in orthopaedic clinical practice cannot be made and further research examining the best type, timing, and content of patients’ decision aids that will lead to maximum patient involvement and knowledge gains with minimal clinical workflow interruption are needed.

Conclusion

In clinical practice today, patients are increasingly involved in clinical decision-making. Further research on SDM in orthopaedic surgery examining the feasibility and impact on practice, on patients’ willingness and ability to actively participate in shared decision-making, and the timing and type of patients’ decision aids appropriate for use is still needed.

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Acknowledgments

We thank the Orthopaedic Research and Education Foundation for their support in funding this study and the Foundation for Informed Medical Decision Making for their support in providing the patients’ decision aids.

Author information

Authors and Affiliations

  1. Department of Orthopaedic Surgery, NYU Hospital for Joint Diseases, 301 East 17th Street, Suite 1616, New York, NY, 10003, USA

    James Slover MD, MS & Jennifer Shue BS

  2. Department of Orthopaedics, Dartmouth-Hitchcock Medical Center, Hanover, NH, USA

    Karl Koenig MD, MS

Authors
  1. James Slover MD, MS
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  2. Jennifer Shue BS
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  3. Karl Koenig MD, MS
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Corresponding author

Correspondence to James Slover MD, MS.

Additional information

The institution of one or more of the authors (JS) has received research funding support from the Orthopaedic Research and Education Foundation and the Foundation for Informed Medical Decision Making for this study.

All ICMJE Conflict of Interest Forms for authors and Clinical Orthopaedics and Related Research editors and board members are on file with the publication and can be viewed on request.

This work was conducted at NYU Hospital for Joint Diseases, New York, NY, USA.

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Slover, J., Shue, J. & Koenig, K. Shared Decision-making in Orthopaedic Surgery. Clin Orthop Relat Res 470, 1046–1053 (2012). https://doi.org/10.1007/s11999-011-2156-8

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