Surgeon Applications of Patient Preferences in Treatment Decision Making for First-Time Anterior Shoulder Dislocation.
Date
2020-12-04
Journal Title
Journal ISSN
Volume Title
Repository Usage Stats
views
downloads
Citation Stats
Abstract
Background
Treatment of a first-time anterior shoulder dislocation (FTASD) is sensitive to patient preferences. The operative or nonoperative management debate provides an excellent opportunity to learn how surgeons apply patient preferences in treatment decisions.Purpose
To determine how patient preferences (repeat dislocation risk, recovery difficulties, fear of surgery, treatment costs) and surgeon factors influence a surgeon's treatment plan for FTASD.Study design
Cross-sectional study.Methods
Eight clinical vignettes of hypothetical patients with FTASD (including age, sex, and activity level) were presented to members of the Magellan Society. A second set of matched vignettes with patient preferences and clinical variables were also presented. The vignettes represented scenarios in which evidence does not favor one treatment over another. Respondents were asked how they would manage each hypothetical case. Respondents also estimated the risk of redislocation for the nonoperative cases for comparison with the published rates. Finally, respondents completed a Likert-scale questionnaire to determine their perceptions on factors influencing their decisions.Results
A total of 103 orthopaedic surgeons completed the survey; 48% practiced in an academic hospital; 79% were in practice for 10 years or longer; and 75% had completed a sports medicine fellowship. Patient preferences were the single most important factor influencing treatment recommendation, with activity type and age also important. Just 62% of the surgeon estimates of the risk of redislocation were consistent with the published rates. The inclusion of patient preferences to clinical variables changed treatment recommendations in 62.5% of our hypothetical cases. Respondents rated patient treatment preference as the leading factor in their treatment decision making.Conclusion
Patient preferences were important when deciding the appropriate treatment for FTASD. Respondents were inconsistent when applying evidence in their decision making and estimates of recurrent instability. Decision support tools that deliver patient preferences and personalized evidence-based outcome estimates improve the quality of decision making at the point of care.Type
Department
Description
Provenance
Citation
Permalink
Published Version (Please cite this version)
Publication Info
Lau, Brian C, Carolyn A Hutyra, Benjamin Streufert, Shelby D Reed, Lori A Orlando, Joel C Huber, Dean C Taylor, Richard C Mather, et al. (2020). Surgeon Applications of Patient Preferences in Treatment Decision Making for First-Time Anterior Shoulder Dislocation. Orthopaedic journal of sports medicine, 8(12). p. 2325967120966145. 10.1177/2325967120966145 Retrieved from https://hdl.handle.net/10161/22459.
This is constructed from limited available data and may be imprecise. To cite this article, please review & use the official citation provided by the journal.
Collections
Scholars@Duke

Brian Chei-Fai Lau
Dr. Lau is an orthopaedic surgeon that is dual fellowship trained in sports medicine/shoulder and foot/ankle. His clinical practice focuses on sports injuries of the shoulder, knee, and ankle. He has clinical and translational research projects with an interests in imaging related research. He participates and leads numerous multi-center trials.

Shelby Derene Reed
Shelby D. Reed, PhD, is Professor in the Departments of Population Health Sciences and Medicine at Duke University’s School of Medicine. She is the director of the Center for Informing Health Decisions and Therapeutic Area leader for Population Health Sciences at the Duke Clinical Research Institute (DCRI). She also is core faculty at the Duke-Margolis Center for Health Policy. Dr. Reed has over 20 years of experience leading multidisciplinary health outcomes research studies. Dr. Reed has extensive expertise in designing and conducting trial-based and model-based cost-effectiveness analyses of diagnostics, drugs and patient-centered interventions. In 2016, she co-founded the Preference Evaluation Research (PrefER) Group at the DCRI, and she currently serves as its director. She and the group are frequently sought to conduct stated-preference studies to inform regulatory decisions, health policy, care delivery, value assessment and clinical decision making with applied projects spanning a wide range of therapeutic areas. She served as President for ISPOR in 2017-2018, and she currently is Past-Chair of the Society’s Health Science Policy Council.
Areas of expertise: Health Economics, Health Measurement, Stated Preference Research, Health Policy, and Health Services Research

Dean Curtis Taylor
Dr. Dean Taylor is a Sports Medicine Orthopaedic Surgeon whose practice and research interests include shoulder instability, shoulder arthroscopy, knee ligament injuries, meniscus injuries, knee cartilage injuries, and ACL injuries in adults and children. He attended the United States Military Academy at West Point and completed his medical training and residency at Duke University. Dr. Taylor went on to be a part of the John Feagin West Point Sports Medicine Fellowship, retired from the United States Army at the rank of Colonel, and returned to Duke in 2006.

Richard Charles Mather
Richard C. “Chad” Mather III MD, MBA is an assistant professor and vice chairman of practice innovation in the Department of Orthopaedic Surgery at Duke University School of Medicine. He is also a faculty member at the Duke Clinical Research Institute. Dr. Mather is a health services researcher and decision scientist with a focus on economic analysis, health policy, health preference measurement and personalized decision-making. His current work focuses on building tools for healthcare consumerism by facilitating measurement and communication of individual patient preferences in treatment decisions. Additionally, he has great interest in health innovation, particularly in developing new care and payment models to foster different incentives and practice approaches. He was a health policy fellow with the American Academy of Orthopaedic Surgeons and the Arthroscopy Association of North America. Dr. Mather received an undergraduate degree in economics from Miami University and a medical doctorate and masters in business administration from Duke, where he also completed residency training in orthopaedic surgery. He completed a sports medicine fellowship at Rush University Medical Center. His clinical practice focuses on hip arthroscopy including both FAI and extra-articular hip endoscopy. Specifically to the hip in addition to health service research applications he conducts translational research on biomarkers and hip instability.
Unless otherwise indicated, scholarly articles published by Duke faculty members are made available here with a CC-BY-NC (Creative Commons Attribution Non-Commercial) license, as enabled by the Duke Open Access Policy. If you wish to use the materials in ways not already permitted under CC-BY-NC, please consult the copyright owner. Other materials are made available here through the author’s grant of a non-exclusive license to make their work openly accessible.