Understanding Preferences for Treatment After Hypothetical First-Time Anterior Shoulder Dislocation: Surveying an Online Panel Utilizing a Novel Shared Decision-Making Tool.

dc.contributor.author

Streufert, Ben

dc.contributor.author

Reed, Shelby D

dc.contributor.author

Orlando, Lori A

dc.contributor.author

Taylor, Dean C

dc.contributor.author

Huber, Joel C

dc.contributor.author

Mather, Richard C

dc.coverage.spatial

United States

dc.date.accessioned

2017-05-01T13:43:48Z

dc.date.available

2017-05-01T13:43:48Z

dc.date.issued

2017-03

dc.description.abstract

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.

dc.identifier

https://www.ncbi.nlm.nih.gov/pubmed/28377932

dc.identifier

10.1177_2325967117695788

dc.identifier.uri

https://hdl.handle.net/10161/14225

dc.language

eng

dc.publisher

SAGE Publications

dc.relation.ispartof

Orthop J Sports Med

dc.relation.isversionof

10.1177/2325967117695788

dc.subject

economic and decision analysis

dc.subject

instability

dc.subject

shoulder

dc.title

Understanding Preferences for Treatment After Hypothetical First-Time Anterior Shoulder Dislocation: Surveying an Online Panel Utilizing a Novel Shared Decision-Making Tool.

dc.type

Journal article

duke.contributor.orcid

Reed, Shelby D|0000-0002-7654-4464

duke.contributor.orcid

Orlando, Lori A|0000-0003-2534-7855

duke.contributor.orcid

Taylor, Dean C|0000-0001-7748-0469

pubs.author-url

https://www.ncbi.nlm.nih.gov/pubmed/28377932

pubs.issue

3

pubs.organisational-group

Clinical Science Departments

pubs.organisational-group

Duke

pubs.organisational-group

Duke Clinical Research Institute

pubs.organisational-group

Institutes and Centers

pubs.organisational-group

Medicine

pubs.organisational-group

Medicine, General Internal Medicine

pubs.organisational-group

Orthopaedics

pubs.organisational-group

School of Medicine

pubs.publication-status

Published online

pubs.volume

5

Files

Original bundle

Now showing 1 - 1 of 1
Loading...
Thumbnail Image
Name:
shoulder dce.pdf
Size:
1.55 MB
Format:
Adobe Portable Document Format
Description:
Published version