Skip to main content
SpringerLink
Log in

Current concepts of shared decision making in orthopedic surgery

  • Orthopaedic Health Policy (A Miller, section editor)
  • Published:
Current Reviews in Musculoskeletal Medicine Aims and scope Submit manuscript

Abstract

Purpose of review

The Shared Decision Making (SDM) model, a collaborative decision making process between the physician and patient to make an informed clinical decision that enhances the chance of treatment success as defined by each patient’s preferences and values, has become a new and promising tool in the healthcare process; however, minimal data exists on its application in the orthopedic surgical specialty. Increasing evidence has demonstrated that this once novel idea can be implemented successfully in the orthopedic setting to improve patient outcomes.

Recent findings

SDM can be applied without significant increases in the office length. Patients report that a physician that takes the time to listen to them is among the most important factors in their care. When time was focused on the SDM process, there was a direct correlation between the time spent with a patient and patient satisfaction. Patients exposed to a decision aid prior to surgery gained a greater knowledge from baseline to make a higher quality decision that was consistent with their values. Involving family members preoperatively can help all patients adhere to postoperative regimens. Exposing patients to a decision aid can reduce expensive elective surgeries, in favor of non-operative management. Incorporating patient goals into the decision-making process has increased satisfaction, compliance, and outcomes.

Summary

SDM is a two-way exchange of information that attempts to correct the inequality of power between the patient and physician. Decision-aids are helpful tools that facilitate the decision-making process. Treatment decisions are consistent with patient preferences and values when there may be no “best” therapy. A good patient–physician relationship is essential during the process to reduce decisional conflict and increase overall patient outcomes.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

Papers of particular interest, published recently, have been highlighted as: • Of importance

  1. Smith MA. The role of shared decision making in patient-centered care and Orthopaedics. Orthop Nurs. 2016;35:144–9.

    Article  PubMed  Google Scholar 

  2. Charles C, Whelan T, Gafni A. What do we mean by partnership in making decisions about treatment? BMJ. 1999;319:780–2.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  3. • Slover J, Shue J, Koenig K. Shared decision-making in orthopaedic surgery. Clin Orthop Relat Res. 2012;470:1046–53. Prior comprehensive review of shared decision making in orthopaedic surgery that sets the foundation for an updated review.

    Article  PubMed  Google Scholar 

  4. Arora NK, McHorney CA. Patient preferences for medical decision making: who really wants to participate? Med Care. 2000;38:335–41.

    Article  CAS  PubMed  Google Scholar 

  5. Barry MJ. Health decision aids to facilitate shared decision making in office practice. Ann Intern Med. 2002;136:127–35.

    Article  PubMed  Google Scholar 

  6. Draeger RW, Stern PJ. Patient-centered care in medicine and surgery: guidelines for achieving patient-centered subspecialty care. Hand Clin. 2014;30:353–9. vii

    Article  PubMed  Google Scholar 

  7. Vranceanu AM, Cooper C, Ring D. Integrating patient values into evidence-based practice: effective communication for shared decision-making. Hand Clin. 2009;25:83–96. vii

    Article  PubMed  Google Scholar 

  8. Charles C, Gafni A, Whelan T. Shared decision-making in the medical encounter: what does it mean? (or it takes at least two to tango). Soc Sci Med. 1997;44:681–92.

    Article  CAS  PubMed  Google Scholar 

  9. Sutherland C, Holleb A. Liability issues. Cancer. 1989;64:2694–5.

    Article  CAS  PubMed  Google Scholar 

  10. Kaplan SH, Greenfield S, Gandek B, Rogers WH, Ware Jr JE. Characteristics of physicians with participatory decision-making styles. Ann Intern Med. 1996;124:497–504.

    Article  CAS  PubMed  Google Scholar 

  11. Frosch DL, Kaplan RM. Shared decision making in clinical medicine: past research and future directions. Am J Prev Med. 1999;17:285–94.

    Article  CAS  PubMed  Google Scholar 

  12. Lavallee DC, Chenok KE, Love RM, et al. Incorporating patient-reported outcomes into health care to engage patients and enhance care. Health Aff (Millwood). 2016;35:575–82.

    Article  Google Scholar 

  13. Hudak PL, Armstrong K, Braddock 3rd C, Frankel RM, Levinson W. Older patients’ unexpressed concerns about orthopaedic surgery. J Bone Joint Surg Am. 2008;90:1427–35.

    Article  PubMed  PubMed Central  Google Scholar 

  14. Karlson EW, Daltroy LH, Liang MH, Eaton HE, Katz JN. Gender differences in patient preferences may underlie differential utilization of elective surgery. Am J Med. 1997;102:524–30.

    Article  CAS  PubMed  Google Scholar 

  15. Hawker GA. Who, when, and why total joint replacement surgery? The patient’s perspective. Curr Opin Rheumatol. 2006;18:526–30.

    PubMed  Google Scholar 

  16. • Youm J, Chan V, Belkora J, Bozic KJ. Impact of socioeconomic factors on informed decision making and treatment choice in patients with hip and knee OA. J Arthroplast. 2015;30:171–5. Evaluates patient socioeconomic factors with different barriers that independently influence the shared decision making process.

    Article  Google Scholar 

  17. Shue J, Karia RJ, Cardone D, Samuels J, Shah M, Slover JD. A randomized controlled trial of two distinct shared decision-making aids for hip and knee osteoarthritis in an ethnically diverse patient population. Value Health. 2016;19:487–93.

    Article  PubMed  Google Scholar 

  18. Strull WM, Lo B, Charles G. Do patients want to participate in medical decision making? JAMA. 1984;252:2990–4.

    Article  CAS  PubMed  Google Scholar 

  19. Deber RB, Kraetschmer N, Irvine J. What role do patients wish to play in treatment decision making? Arch Intern Med. 1996;156:1414–20.

    Article  CAS  PubMed  Google Scholar 

  20. Deber RB, Kraetschmer N, Urowitz S, Sharpe N. Do people want to be autonomous patients? Preferred roles in treatment decision-making in several patient populations. Health Expect. 2007;10:248–58.

    Article  PubMed  PubMed Central  Google Scholar 

  21. Levinson W, Kao A, Kuby A, Thisted RA. Not all patients want to participate in decision making. A national study of public preferences. J Gen Intern Med. 2005;20:531–5.

    Article  PubMed  PubMed Central  Google Scholar 

  22. Say R, Murtagh M, Thomson R. Patients’ preference for involvement in medical decision making: a narrative review. Patient Educ Couns. 2006;60:102–14.

    Article  PubMed  Google Scholar 

  23. Doring AC, Hageman MG, Mulder FJ, et al. Trigger finger: assessment of surgeon and patient preferences and priorities for decision making. J Hand Surg Am. 2014;39:2208–13. e2

    Article  PubMed  Google Scholar 

  24. Hageman MG, Kinaci A, Ju K, et al. Carpal tunnel syndrome: assessment of surgeon and patient preferences and priorities for decision-making. J Hand Surg Am. 2014;39:1799–804. e1

    Article  PubMed  Google Scholar 

  25. Frymoyer JW, Frymoyer NP. Physician–patient communication: a lost art? J Am Acad Orthop Surg. 2002;10:95–105.

    Article  PubMed  Google Scholar 

  26. O'Neill J, Williams JR, Kay LJ. Doctor–patient communication in a musculoskeletal unit: relationship between an observer-rated structured scoring system and patient opinion. Rheumatology (Oxford). 2003;42:1518–22.

    Article  Google Scholar 

  27. Dugdale DC, Epstein R, Pantilat SZ. Time and the patient-physician relationship. J Gen Intern Med. 1999;14(Suppl 1):S34–40.

    Article  PubMed  PubMed Central  Google Scholar 

  28. O'Connor AM, Stacey D, Entwistle V, et al. Decision aids for people facing health treatment or screening decisions. Cochrane Database Syst Rev. 2003:CD001431.

  29. Molenaar S, Sprangers MA, Postma-Schuit FC, et al. Feasibility and effects of decision aids. Med Decis Mak. 2000;20:112–27.

    Article  CAS  Google Scholar 

  30. de Achaval S, Fraenkel L, Volk RJ, Cox V, Suarez-Almazor ME. Impact of educational and patient decision aids on decisional conflict associated with total knee arthroplasty. Arthritis Care Res (Hoboken). 2012;64:229–37.

    Article  Google Scholar 

  31. Ten Have IA, van den Bekerom MP, van Deurzen DF, Hageman MG. Role of decision aids in orthopaedic surgery. World J Orthop. 2015;6:864–6.

    Article  PubMed  PubMed Central  Google Scholar 

  32. Deber RB. Physicians in. health care management: 8. The patient-physician partnership: decision making, problem solving and the desire to participate. CMAJ. 1994;151:423–7.

    CAS  PubMed  PubMed Central  Google Scholar 

  33. Evans R, Elwyn G, Edwards A. Making interactive decision support for patients a reality. Inform Prim Care. 2004;12:109–13.

    PubMed  Google Scholar 

  34. Lurie JD, Spratt KF, Blood EA, Tosteson TD, Tosteson AN, Weinstein JN. Effects of viewing an evidence-based video decision aid on patients’ treatment preferences for spine surgery. Spine (Phila Pa 1976). 2011;36:1501–4.

    Article  Google Scholar 

  35. Shirley E, Bejarano C, Clay C, Fuzzell L, Leonard S, Wysocki T. Helping families make difficult choices: creation and implementation of a decision aid for neuromuscular scoliosis surgery. J Pediatr Orthop. 2015;35:831–7.

    PubMed  Google Scholar 

  36. Stacey D, Hawker G, Dervin G, et al. Decision aid for patients considering total knee arthroplasty with preference report for surgeons: a pilot randomized controlled trial. BMC Musculoskelet Disord. 2014a;15:54.

    Article  PubMed  PubMed Central  Google Scholar 

  37. Weng HH, Kaplan RM, Boscardin WJ, et al. Development of a decision aid to address racial disparities in utilization of knee replacement surgery. Arthritis Rheum. 2007;57:568–75.

    Article  PubMed  Google Scholar 

  38. • Bozic KJ, Belkora J, Chan V, et al. Shared decision making in patients with osteoarthritis of the hip and knee: results of a randomized controlled trial. J Bone Joint Surg Am. 2013;95:1633–9. Results of clinical trial provide evidence supporting benefits to surgeons and patients using shared decision making in orthopaedic practice.

    Article  PubMed  Google Scholar 

  39. Hutchinson RH, Barrie JL. The effects of shared decision making in the conservative management of stable ankle fractures. Injury. 2015;46:1116–8.

    Article  CAS  PubMed  Google Scholar 

  40. Phelan EA, Deyo RA, Cherkin DC, et al. Helping patients decide about back surgery: a randomized trial of an interactive video program. Spine (Phila Pa 1976). 2001;26:206–11. discussion 12.

    Article  CAS  Google Scholar 

  41. Fraenkel L, Rabidou N, Wittink D, Fried T. Improving informed decision-making for patients with knee pain. J Rheumatol. 2007;34:1894–8.

    PubMed  Google Scholar 

  42. Adam JA, Khaw FM, Thomson RG, Gregg PJ, Llewellyn-Thomas HA. Patient decision aids in joint replacement surgery: a literature review and an opinion survey of consultant orthopaedic surgeons. Ann R Coll Surg Engl. 2008;90:198–207.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  43. Spunt BS, Deyo RA, Taylor VM, Leek KM, Goldberg HI, Mulley AG. An interactive videodisc program for low back pain patients. Health Educ Res. 1996;11:535–41.

    Article  CAS  PubMed  Google Scholar 

  44. Perestelo-Perez L, Perez-Ramos J, Gonzalez-Lorenzo M, Rivero-Santana A, Serrano-Aguilar P. Decision aids for patients facing health treatment decisions in Spain: preliminary results. Patient Educ Couns. 2010;80:364–71.

    Article  PubMed  Google Scholar 

  45. Kearing S, Berg SZ, Lurie JD. Can decision support help patients with spinal stenosis make a treatment choice?: a prospective study assessing the impact of a patient decision aid and health coaching. Spine (Phila Pa 1976). 2016;41:563–7.

    Article  Google Scholar 

  46. Washington K, Shacklady C. Patients’ experience of shared decision making using an online patient decision aid for osteoarthritis of the knee—a service evaluation. Musculoskeletal Care. 2015;13:116–26.

    Article  PubMed  Google Scholar 

  47. Braddock 3rd C, Hudak PL, Feldman JJ, Bereknyei S, Frankel RM, Levinson W. “Surgery is certainly one good option”: quality and time-efficiency of informed decision-making in surgery. J Bone Joint Surg Am. 2008;90:1830–8.

    Article  PubMed  PubMed Central  Google Scholar 

  48. Stacey D, Legare F, Col NF, et al. Decision aids for people facing health treatment or screening decisions. Cochrane Database Syst Rev. 2014b:CD001431.

  49. Youm J, Chenok KE, Belkora J, Chiu V, Bozic KJ. The emerging case for shared decision making in orthopaedics. Instr Course Lect. 2013;62:587–94.

    PubMed  Google Scholar 

  50. • Ho A, Pinney SJ, Bozic K. Ethical concerns in caring for elderly patients with cognitive limitations: a capacity-adjusted shared decision-making approach. J Bone Joint Surg Am. 2015;97:e16. Describes capacity adjusted approaches to shared decision models for patients with cognitive impairment undergoing surgical procedures.

    Article  PubMed  Google Scholar 

  51. Moskop JC. Informed consent and refusal of treatment: challenges for emergency physicians. Emerg Med Clin North Am. 2006;24:605–18.

    Article  PubMed  Google Scholar 

  52. Langdon IJ, Hardin R, Learmonth ID. Informed consent for total hip arthroplasty: does a written information sheet improve recall by patients? Ann R Coll Surg Engl. 2002;84:404–8.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  53. Saigal R, Clark AJ, Scheer JK, et al. Adult spinal deformity patients recall fewer than 50% of the risks discussed in the informed consent process preoperatively and the recall rate worsens significantly in the postoperative period. Spine (Phila Pa 1976). 2015;40:1079–85.

    Article  Google Scholar 

  54. Schillinger D, Piette J, Grumbach K, et al. Closing the loop: physician communication with diabetic patients who have low health literacy. Arch Intern Med. 2003;163:83–90.

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Philadelphia College of Osteopathic Medicine, Philadelphia, USA

    Kevin Klifto

  2. NYU Langone Medical Center Department of Orthopaedic Surgery, NYU Hospital for Joint Diseases, 301 East 17th Street; Suite 213, New York, NY, 10003, USA

    Christopher Klifto & James Slover

Authors
  1. Kevin Klifto
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Christopher Klifto
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. James Slover
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to James Slover.

Ethics declarations

Conflict of interest

All authors declare that they have no conflict of interest.

Human and animal rights and informed consent

This article does not contain any studies with human or animal subjects performed by any of the authors.

Additional information

This article is part of the Topical Collection on Orthopedic Health Policy

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Klifto, K., Klifto, C. & Slover, J. Current concepts of shared decision making in orthopedic surgery. Curr Rev Musculoskelet Med 10, 253–257 (2017). https://doi.org/10.1007/s12178-017-9409-4

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s12178-017-9409-4

Keywords

Search

Navigation