Department of Orthopaedic Surgery, Stanford University, Redwood City, CA, USA.
Clin Orthop Relat Res. 2018 Sep;476(9):1859-1865. doi: 10.1097/CORR.0000000000000365.
Shared decision-making between patients and physicians involves educating the patient, providing options, eliciting patient preferences, and reaching agreement on a decision. There are different ways to measure shared decision-making, including patient involvement, but there is no consensus on the best approach. In other fields, there have been varying relationships between patient-perceived involvement and observed patient involvement in shared decision-making. The relationship between observed and patient-perceived patient involvement in decision-making has not been studied in orthopaedic surgery.
QUESTIONS/PURPOSES: (1) Does patient-perceived involvement correlate with observed measurements of patient involvement in decision-making in orthopaedic surgery? (2) Are patient demographics associated with perceived and observed measurements of patient involvement in decision-making?
We performed a prospective, observational study to compare observed and perceived patient involvement in new patient consultations for eight orthopaedic surgeons in subspecialties including hand/upper extremity, total joint arthroplasty, spine, sports, trauma, foot and ankle, and tumor. We enrolled 117 English-literate patients 18 years or older over an enrollment period of 2 months. A member of the research team assessed observed patient involvement during a consultation with the Observing Patient Involvement in Decision-Making (OPTION) instrument (scaled 1-100 with higher scores representing greater involvement). After the consultation, we asked patients to complete a questionnaire with demographic information including age, sex, race, education, income, marital status, employment status, and injury type. Patients also completed the Perceived Involvement in Care Scale (PICS), which measures patient-perceived involvement (scaled 1-13 with higher scores representing greater involvement). Both instruments are validated in multiple studies in various specialties and the physicians were blinded to the instruments used. We assessed the correlation between observed and patient-perceived involvement as well as tested the association between patient demographics and patient involvement scores.
There was weak correlation between observed involvement (OPTION) and patient-perceived involvement (PICS) (r = 0.37, p < 0.01) in decision-making (mean OPTION, 28.7, SD 7.7; mean PICS, 8.43, SD 2.3). We found a low degree of observed patient involvement despite a moderate to high degree of perceived involvement. No patient demographic factor had a significant association with patient involvement.
Further work is needed to identify the best method for evaluating patient involvement in decision-making in the setting of discordance between observed and patient-perceived measurements. Knowing whether it is necessary for (1) actual observable patient involvement to occur; or (2) a patient to simply believe they are involved in their care can inform physicians on the best way to improve shared decision-making in their practice.
Level II, therapeutic study.
患者与医生之间的共同决策包括教育患者、提供选择、引出患者的偏好，并就决策达成一致。有不同的方法来衡量共同决策，包括患者的参与度，但对于最佳方法尚无共识。在其他领域，患者感知的参与度与观察到的共同决策中的患者参与度之间存在不同的关系。在矫形外科手术中，尚未研究观察到的和患者感知的患者在决策中的参与度之间的关系。
问题/目的：（1）患者感知的参与度是否与矫形外科手术中观察到的决策中患者参与度的测量值相关？（2）患者人口统计学特征与患者对决策的感知和观察到的参与度测量值相关吗？
我们进行了一项前瞻性、观察性研究，比较了 8 名矫形外科医生的新患者咨询中观察到的和患者感知的参与度，这些医生的专业领域包括手/上肢、全关节置换术、脊柱、运动、创伤、足踝和肿瘤。在 2 个月的入组期间，我们招募了 117 名 18 岁或以上的英语熟练的患者。研究团队的一名成员使用观察患者参与决策（OPTION）工具（评分 1-100，得分越高表示参与度越高）评估了咨询过程中的观察到的患者参与度。咨询结束后，我们让患者填写一份包括年龄、性别、种族、教育程度、收入、婚姻状况、就业状况和受伤类型等人口统计学信息的问卷。患者还完成了感知参与护理量表（PICS），该量表衡量患者感知的参与度（评分 1-13，得分越高表示参与度越高）。这两个工具都在多个专业领域的多项研究中得到了验证，医生对使用的工具是盲目的。我们评估了观察到的和患者感知的参与度之间的相关性，并测试了患者人口统计学特征与患者参与度评分之间的关联。
在决策中，观察到的参与度（OPTION）与患者感知的参与度（PICS）之间存在弱相关（r = 0.37，p < 0.01）（平均 OPTION，28.7，SD 7.7；平均 PICS，8.43，SD 2.3）。尽管患者感知的参与度为中度至高度，但观察到的患者参与度较低。没有患者人口统计学因素与患者参与度有显著关联。
需要进一步研究以确定在观察到的和患者感知的测量值不一致的情况下评估决策中患者参与度的最佳方法。了解（1）实际可观察到的患者参与度是否必须发生；或者（2）患者只需相信他们参与了自己的护理，这可以为医生提供有关在实践中如何改善共同决策的信息。
II 级，治疗研究。
