Department of Orthopaedic Surgery, Hanil General Hospital, Seoul, Korea.
Department of Orthopedic Surgery, Seoul National University Bundang Hospital, Seongnam, Korea.
Clin Orthop Surg. 2021 Mar;13(1):18-23. doi: 10.4055/cios20092. Epub 2021 Jan 11.
Patients experiencing acute trauma have limited time for their involvement in shared decision making, which may lead to decisional conflict. The purpose of this study was to evaluate whether providing audiovisual surgical information can reduce decisional conflict when deciding between surgical and nonsurgical treatment in patients with distal radius fractures (DRFs) and to evaluate factors that may affect decisional conflict.
We prospectively enrolled 50 consecutive patients who presented with acute DRFs and chose to undergo surgery, for which volar plate fixation was recommended. We randomized these patients into 2 groups. The test group was given a video clip of audiovisual surgical information in addition to regular information while the control group was only given regular information. The video clip consisted of the purpose, procedure, and effect of the surgery, precautions and complications after the operation, and other treatment options that could be performed if operation was not performed. At 2 weeks after the surgery, we evaluated patients' decisional conflict using a decisional conflict scale (DCS). In addition, we evaluated factors that might affect decisional conflict, such as age, dominant hand, comorbidities, history of previous operations, perceived disability, and provision of the video clip.
The test group showed significantly lower DCS scores than the control group (19.6 vs. 32.1, = 0.001). In multivariate analysis, younger age and provision of the video clip were associated with lower DCS scores.
This study has demonstrated that providing information through audiovisual media such as video clips could reduce decisional conflict in patients who chose to undergo plate fixation for DRFs. This study also suggests that older patients may need more careful doctor-patient communication as they have more decisional conflict than younger patients.
急性创伤患者参与决策的时间有限，这可能导致决策冲突。本研究旨在评估在桡骨远端骨折（DRF）患者中，提供视听手术信息是否可以减少手术和非手术治疗之间的决策冲突，并评估可能影响决策冲突的因素。
我们前瞻性地招募了 50 名连续出现急性 DRF 并选择接受手术治疗的患者，建议行掌侧钢板固定术。我们将这些患者随机分为 2 组。实验组除了常规信息外，还给予视听手术信息的视频剪辑，而对照组仅给予常规信息。视频剪辑包括手术的目的、过程和效果、术后注意事项和并发症，以及如果不进行手术可以进行的其他治疗选择。在手术后 2 周，我们使用决策冲突量表（DCS）评估患者的决策冲突。此外，我们还评估了可能影响决策冲突的因素，如年龄、优势手、合并症、既往手术史、感知残疾和视频剪辑的提供。
实验组的 DCS 评分明显低于对照组（19.6 对 32.1， = 0.001）。多变量分析显示，年龄较小和提供视频剪辑与较低的 DCS 评分相关。
本研究表明，通过视频等视听媒体提供信息可以减少选择接受 DRF 钢板固定术的患者的决策冲突。本研究还表明，老年患者可能需要更仔细的医患沟通，因为他们的决策冲突比年轻患者更多。
