Do patient preferences influence surgeon recommendations for treatment?

Lisanne J.H. Smits, Suzanne C. Wilkens, Neal C. Chen, David Ring, Thierry G. Guitton

Research output: Contribution to journalArticle

Abstract

Background: When the best treatment option is uncertain, a patient's preference based on personal values should be the source of most variation in diagnostic and therapeutic interventions. Unexplained surgeon-to-surgeon variation in treatment for hand and upper extremity conditions suggests that surgeon preferences have more influence than patient preferences. Methods: A total of 184 surgeons reviewed 18 fictional scenarios of upper extremity conditions for which operative treatment is discretionary and preference sensitive, and recommended either operative or non-operative treatment. To test the influence of six specific patient preferences the preference was randomly assigned to each scenario in an affirmative or negative manner. Surgeon characteristics were collected for each participant. Results: Of the six preferences studied, four influenced surgeon recommendations. Surgeons were more likely to recommend non-operative treatment when patients; preferred the least expensive treatment (adjusted OR, 0.82; 95% CI, 0.71 - 0.94; P=0.005), preferred non-operative treatment (adjusted OR, 0.82; 95% CI, 0.72 - 0.95; P=0.006), were not concerned about aesthetics (adjusted OR, 1.15; 95% CI, 1.0 - 1.3; P=0.046), and when patients only preferred operative treatment if there is consensus among surgeons that operative treatment is a useful option (adjusted OR, 0.78; 95% CI, 0.68 - 0.89; P<0.001). Conclusion: Patient preferences were found to have a measurable influence on surgeon treatment recommendations though not as much as we expected-and surgeons on average interpreted surgery as more aesthetic. This emphasizes the importance of strategies to help patients reflect on their values and ensure their preferences are consistent with those values (e.g. use of decision-aids).

Original languageEnglish (US)
Pages (from-to)118-135
Number of pages18
JournalArchives of Bone and Joint Surgery
Volume7
Issue number2
StatePublished - Jan 1 2019

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Patient Preference
Therapeutics
Esthetics
Upper Extremity
Surgeons
Decision Support Techniques
Consensus
Hand

Keywords

  • Conservative treatment
  • Decision making
  • Patient preference
  • Surgery

ASJC Scopus subject areas

  • Surgery
  • Orthopedics and Sports Medicine

Cite this

Smits, L. J. H., Wilkens, S. C., Chen, N. C., Ring, D., & Guitton, T. G. (2019). Do patient preferences influence surgeon recommendations for treatment? Archives of Bone and Joint Surgery, 7(2), 118-135.

Do patient preferences influence surgeon recommendations for treatment? / Smits, Lisanne J.H.; Wilkens, Suzanne C.; Chen, Neal C.; Ring, David; Guitton, Thierry G.

In: Archives of Bone and Joint Surgery, Vol. 7, No. 2, 01.01.2019, p. 118-135.

Research output: Contribution to journalArticle

Smits, LJH, Wilkens, SC, Chen, NC, Ring, D & Guitton, TG 2019, 'Do patient preferences influence surgeon recommendations for treatment?', Archives of Bone and Joint Surgery, vol. 7, no. 2, pp. 118-135.
Smits, Lisanne J.H. ; Wilkens, Suzanne C. ; Chen, Neal C. ; Ring, David ; Guitton, Thierry G. / Do patient preferences influence surgeon recommendations for treatment?. In: Archives of Bone and Joint Surgery. 2019 ; Vol. 7, No. 2. pp. 118-135.
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abstract = "Background: When the best treatment option is uncertain, a patient's preference based on personal values should be the source of most variation in diagnostic and therapeutic interventions. Unexplained surgeon-to-surgeon variation in treatment for hand and upper extremity conditions suggests that surgeon preferences have more influence than patient preferences. Methods: A total of 184 surgeons reviewed 18 fictional scenarios of upper extremity conditions for which operative treatment is discretionary and preference sensitive, and recommended either operative or non-operative treatment. To test the influence of six specific patient preferences the preference was randomly assigned to each scenario in an affirmative or negative manner. Surgeon characteristics were collected for each participant. Results: Of the six preferences studied, four influenced surgeon recommendations. Surgeons were more likely to recommend non-operative treatment when patients; preferred the least expensive treatment (adjusted OR, 0.82; 95{\%} CI, 0.71 - 0.94; P=0.005), preferred non-operative treatment (adjusted OR, 0.82; 95{\%} CI, 0.72 - 0.95; P=0.006), were not concerned about aesthetics (adjusted OR, 1.15; 95{\%} CI, 1.0 - 1.3; P=0.046), and when patients only preferred operative treatment if there is consensus among surgeons that operative treatment is a useful option (adjusted OR, 0.78; 95{\%} CI, 0.68 - 0.89; P<0.001). Conclusion: Patient preferences were found to have a measurable influence on surgeon treatment recommendations though not as much as we expected-and surgeons on average interpreted surgery as more aesthetic. This emphasizes the importance of strategies to help patients reflect on their values and ensure their preferences are consistent with those values (e.g. use of decision-aids).",
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