Understanding Preferences for Treatment After Hypothetical First-Time Anterior Shoulder Dislocation: Surveying an Online Panel Utilizing a Novel Shared Decision-Making Tool.
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2017-03
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BACKGROUND: Although surgical management of a first-time anterior shoulder dislocation (FTASD) can reduce the risk of recurrent dislocation, other treatment characteristics, costs, and outcomes are important to patients considering treatment options. While patient preferences, such as those elicited by conjoint analysis, have been shown to be important in medical decision-making, the magnitudes or effects of patient preferences in treating an FTASD are unknown. PURPOSE: To test a novel shared decision-making tool after sustained FTASD. Specifically measured were the following: (1) importance of aspects of operative versus nonoperative treatment, (2) respondents' agreement with results generated by the tool, (3) willingness to share these results with physicians, and (4) association of results with choice of treatment after FTASD. STUDY DESIGN: Cross-sectional study; Level of evidence, 3. METHODS: A tool was designed and tested using members of Amazon Mechanical Turk, an online panel. The tool included an adaptive conjoint analysis exercise, a method to understand individuals' perceived importance of the following attributes of treatment: (1) chance of recurrent dislocation, (2) cost, (3) short-term limits on shoulder motion, (4) limits on participation in high-risk activities, and (5) duration of physical therapy. Respondents then chose between operative and nonoperative treatment for hypothetical shoulder dislocation. RESULTS: Overall, 374 of 501 (75%) respondents met the inclusion criteria, of which most were young, active males; one-third reported prior dislocation. From the conjoint analysis, the importance of recurrent dislocation and cost of treatment were the most important attributes. A substantial majority agreed with the tool's ability to generate representative preferences and indicated that they would share these preferences with their physician. Importance of recurrence proved significantly predictive of respondents' treatment choices, independent of sex or age; however, activity level was important to previous dislocators. A total of 125 (55%) males and 33 (23%) females chose surgery after FTASD, as did 37% of previous dislocators compared with 45% of nondislocators. CONCLUSION: When given thorough information about the risks and benefits, respondents had strong preferences for operative treatment after an FTASD. Respondents agreed with the survey results and wanted to share the information with providers. Recurrence was the most important attribute and played a role in decisions about treatment.
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Streufert, Ben, Shelby D Reed, Lori A Orlando, Dean C Taylor, Joel C Huber and Richard C Mather (2017). Understanding Preferences for Treatment After Hypothetical First-Time Anterior Shoulder Dislocation: Surveying an Online Panel Utilizing a Novel Shared Decision-Making Tool. Orthop J Sports Med, 5(3). 10.1177/2325967117695788 Retrieved from https://hdl.handle.net/10161/14225.
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Scholars@Duke
![Orlando](https://scholars.duke.edu/profile-images/thumbnail200/0294963.jpg)
Lori Ann Orlando
Dr. Lori A. Orlando, MD MHS MMCI is a Professor of Medicine and Director of the Precision Medicine Program in the Center for Applied Genomics and Precision Medicine at Duke University. She attended Tulane Medical Center for both medical school (1994-1998) and Internal Medicine residency (1998-2000). There she finished AOA and received a number of awards for teaching and clinical care from the medical school and the residency programs, including the Musser-Burch-Puschett award in 2000 for academic excellence. After completing her residency, she served as Chief Medical Resident in Internal Medicine (2001) and then completed a Health Services Research Fellowship at Duke University Medical Center (2002-2004). In 2004 she also received her MHS from the Clinical Research Training Program at Duke University and joined the academic faculty at Duke. In 2005 she received the Milton W. Hamolsky Award for Outstanding Junior Faculty by the Society of General Internal Medicine. Her major research interests are decision making and patient preferences, implementation research, risk stratification for targeting preventive health services, and decision modeling. From 2004-2009 she worked with Dr. David Matchar in the Center for Clinical Heath Policy Research (CCHPR), where she specialized in decision modeling, decision making, and technology assessments. In 2009 she began working with Dr. Geoffrey Ginsburg in what is now the Center for Applied Genomics and Precision Medicine (CAGPM) and in 2014 she became the director of the Center’s Precision Medicine Program. Since joining the CAGPM she has been leading the development and implementation of MeTree, a patient-facing family health history based risk assessment and clinical decision support program designed to facilitate the uptake of risk stratified evidence-based guidelines. MeTree was designed to overcome the major barriers to collecting and using high quality family health histories to guide clinical care and has been shown to be highly effective when integrated into primary care practices. This effort started with the Genomic Medicine Model, a multi-institutional project, whose goal was to implement personalized medicine in primary care practices. The success of that project has led to funding as part of NHGRI’s IGNITE (Implementing Genomics in Clinical Practice) network. She is currently testing methods for integrating patient preferences and decision making processes into clinical decision support recommendations for patients and providers to facilitate management of patients’ risk for chronic disease using mHealth and other behavioral interventions.
![Taylor](https://scholars.duke.edu/profile-images/thumbnail200/0081152.jpg)
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.
![Huber](https://scholars.duke.edu/profile-images/thumbnail200/0099700.jpg)
Joel C. Huber
Joel Huber is the Alan D. Schwartz Professor Emeritus at the Fuqua School of Business. He and John McCann were founding members of the Marketing area when they arrived at Fuqua in 1979. Professor Huber received his undergraduate degree from Princeton and his MBA and Ph.D. from the Wharton School of the University of Pennsylvania. In addition to Fuqua, he has taught at the business schools at Penn, Columbia and Purdue University. He was Associate Dean for the Daytime program at Fuqua from 1995-1999. He is on the review boards and an associate editor for the leading marketing journals and was the Editor for the Journal of Marketing Research from 2006-2009. Professor Huber retired in 2021.
Professor Huber’s research interest focuses on predicting and understanding market choice. His major focus on predicting choices has led him to develop new ways to measure preference through choice-based conjoint analysis. He has worked for many years with Sawtooth Software and others to help develop new ways to assess valuations. These valuations enable companies to estimate the extent to which new offerings will impact sales within product line. More recent work arises from a series of grants from the US Environmental Protection agency to measure the value of cleaner lakes and streams and healthier drinking water.
Professor Huber has also done substantial work understanding choices. His 1982 article in the Journal of Consumer Research, “Adding Asymmetrically Dominated Alternatives: Violations of Regularity and the Similarity Process,” with Fuqua colleague, John Payne, and Ph.D. student Chris Puto won the Sheth Foundation award for the its long term contribution to consumer research.
![Mather](https://scholars.duke.edu/profile-images/thumbnail200/0280209.jpg)
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.
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