Center for Analytics, Modeling, and Performance, Hospital for Special Surgery, New York, NY, USA; Center for the Advancement of Value in Musculoskeletal Care, Hospital for Special Surgery, New York, NY, USA; Department of Population Health Sciences, Weill Cornell Medical College, New York, NY, USA.
Center for the Advancement of Value in Musculoskeletal Care, Hospital for Special Surgery, New York, NY, USA; Duke University School of Medicine, Durham, NC, USA.
J Arthroplasty. 2022 Apr;37(4):624-629.e18. doi: 10.1016/j.arth.2021.12.021. Epub 2021 Dec 21.
Decisions regarding care for osteoarthritis involve physicians helping patients understand likely benefits and harms of treatment. Little work has directly compared patient and surgeon risk-taking attitudes, which may help inform strategies for shared decision-making and improve patient satisfaction.
We surveyed patients contemplating total joint arthroplasty visiting a high-volume specialty hospital regarding general questions about risk-taking, as well as willingness to undergo surgery under hypothetical likelihoods of moderate improvement and complications. We compared responses from surgeons answering similar questions about willingness to recommend surgery.
Altogether 82% (162/197) of patients responded, as did 65% (30/46) of joint replacement surgeons. Mean age among patients was 66.4 years; 58% were female. Surgeons averaged 399 surgeries in 2019. Responses were similar between groups for general, health, career, financial, and sports/leisure risk-taking (P > .20); surgeons were marginally more risk-taking in driving (P = .05). For willingness to have or recommend surgery, as the chance of benefit decreased, or the chance of harm increased, the percentage willing to have or recommend surgery decreased. Between a 70% and 95% chance of moderate improvement (for a 2% complication risk), as well as between a 90% and 95% chance of moderate improvement (for 4% and 6% complication risks), the percentage willing to have or recommend surgery was indistinguishable between patients and surgeons. However, for lower likelihoods of improvement, a higher percentage of patients were willing to undergo surgery than surgeons recommended. Patients were also more often indifferent between complication risks.
Although patients and surgeons were often willing to have or recommend joint replacement surgery at similar rates, they diverged for lower-benefit higher-harm scenarios.
在决定骨关节炎的治疗方案时，医生需要帮助患者了解治疗的预期获益和潜在风险。目前鲜有研究直接比较患者和外科医生的风险偏好，而这可能有助于确定共同决策的策略，并提高患者满意度。
我们调查了在一家高容量专科医院就诊的拟行全关节置换术的患者，了解他们在一般风险承担问题上的看法，以及在手术获益和并发症发生概率的假设情景下是否愿意接受手术。我们比较了外科医生在类似问题上对手术推荐意愿的回答。
共有 197 名患者（82%）和 46 名关节置换外科医生（65%）做出了回应。患者的平均年龄为 66.4 岁，58%为女性。外科医生在 2019 年平均完成了 399 例手术。两组在一般、健康、职业、财务和运动/休闲风险承担方面的回答相似（P>.20）；在驾驶风险承担方面，外科医生略高（P=0.05）。随着获益机会减少或伤害机会增加，愿意接受手术或推荐手术的比例也随之下降。在中等获益（2%并发症风险）概率为 70%至 95%的情况下，以及在中等获益（4%和 6%并发症风险）概率为 90%至 95%的情况下，患者和外科医生对接受手术或推荐手术的意愿比例没有区别。然而，在获益可能性较低的情况下，愿意接受手术的患者比例高于外科医生推荐的比例。患者在并发症风险之间也往往不做区分。
尽管患者和外科医生在相似的获益和风险水平下往往愿意接受或推荐关节置换手术，但在获益较低、风险较高的情况下，两者的意见存在分歧。
