Woltz Sarah, Krijnen Pieta, Meylaerts Sven A G, Pieterse Arwen H, Schipper Inger B
Department of Trauma Surgery, Leiden University Medical Center, Leiden, The Netherlands.
Department of Trauma Surgery, Leiden University Medical Center, Leiden, The Netherlands.
Injury. 2017 Apr;48(4):920-924. doi: 10.1016/j.injury.2017.02.032. Epub 2017 Feb 27.
Most patients with a displaced midshaft clavicular fracture can be treated either operatively or nonoperatively, with similar long-term outcomes. The treatment choice depends on individual preferences, and is therefore suited for a shared decision making (SDM) approach. However, little is known about SDM in fracture treatment. The purpose of this study was to evaluate the current daily practice of shared decisional behaviour in clavicular fracture treatment, in order to assess the need for improvement and set a baseline level for future research.
All consecutive adult patients treated in two hospitals for a displaced, midshaft clavicular fracture in 2015 filled out a questionnaire shortly after the decision making moment, that consisted of questions concerning their knowledge and preferences regarding the treatment options; the SDM-Q-9-NL to measure the perceived degree of SDM, and the Control Preferences Scale to measure patients' preferred and actual roles in decision making.
Fifty patients were included. Eighteen percent of the patients were unaware of the treatment options before the consultation, 48% had no preference for either treatment option. The mean score for perceived degree of SDM was 74 out of 100 (SD 23, range 12.5-100). In 68% of patients, the preferred role matched the actual role in making the decision. Sixteen patients (32%) would have preferred either a less (n=8) or a more (n=8) active role.
The patient-reported level of SDM in treatment decisions for clavicular fractures was high, but not all patients had the role in this process that they preferred. To improve patients' involvement in the treatment decision making process for clavicular fractures, it is important to create general awareness about SDM, and increase knowledge of orthopaedic trauma surgeons about SDM behaviour.
大多数中段锁骨移位骨折患者可采用手术或非手术治疗，长期疗效相似。治疗选择取决于个人偏好，因此适合采用共同决策（SDM）方法。然而，对于骨折治疗中的共同决策了解甚少。本研究的目的是评估锁骨骨折治疗中共同决策行为的当前日常实践，以评估改进的必要性并为未来研究设定基线水平。
2015年在两家医院接受治疗的所有连续性成年中段锁骨移位骨折患者在决策后不久填写了一份问卷，问卷包括有关他们对治疗选择的知识和偏好的问题；用于测量共同决策感知程度的SDM-Q-9-NL，以及用于测量患者在决策中偏好和实际角色的控制偏好量表。
纳入50例患者。18%的患者在咨询前不知道治疗选择，48%对任何一种治疗选择都没有偏好。共同决策感知程度的平均得分为74分（满分100分，标准差23，范围12.5-100）。68%的患者在决策中偏好的角色与实际角色相符。16例患者（32%）希望在决策中扮演更积极（n=8）或较不积极（n=8）的角色。
患者报告的锁骨骨折治疗决策中共同决策水平较高，但并非所有患者在这一过程中都扮演他们偏好的角色。为提高患者在锁骨骨折治疗决策过程中的参与度，重要的是提高对共同决策的普遍认识，并增加骨科创伤外科医生对共同决策行为的了解。
