ROSEMONT, Ill. (December 8, 2020)—The importance of involving patients in the decision-making process for orthopaedic surgical procedures is the focus of a new review article published in the December issue of the Journal of the American Academy of Orthopaedic Surgeons^® (JAAOS). The literature review took a close look at the concept and practice of shared decision-making (SDM) and the ways it empowers patients to make educated decisions that are aligned with their views and values. 

SDM is a process of communication between the physician and a patient that incorporates a two-way exchange of information in which the physician, an expert in evidence, educates the patient on the risks, benefits and alternatives to treatment. The patient, an expert in themselves, educates the physician on their values and preferences so the two parties can come to a mutual decision.[i]^, [ii] Studies suggest that most patients prefer to share decisions with physicians rather than take on completely autonomous or passive roles.[iii]^,[iv] 

SDM has been shown to:

• Reduce decisional conflict (e.g., uncertainty over which course of action to take)
• Increase patient knowledge[v]
• Improve health outcomes and increase patient satisfaction[vi]

“Shared decision-making is a partnership fueled by a discussion that should be initiated by the physician,” said Robert A. Probe, MD, FAAOS, orthopaedic surgeon at Baylor Scott & White Health, Temple, TX. “Our experience suggests that many orthopaedic surgeons lack an understanding of how to actually engage in SDM or received insufficient communications skills training in medical school and residency. While some physicians can naturally communicate and already incorporate SDM in patient care, there are still a lot who don’t. The goal of this review was to raise awareness and help the orthopaedic community and patients become more educated on the topic.”

Ideally, SDM begins with an invitation from the physician demonstrating their eagerness to engage in a shared decision process. However, Dr. Probe also encourages patients who sense that their perspective is not being fully considered, to bring these important considerations to the fore. Tactful transitions such as “Could we explore how your medical information fits into my life?” sends a clear message to the physician that there are other important considerations beyond what they already know. Once the data set for the decision is established, both parties embark on bringing their unique contributions to the conversation.

The patient can share their feelings about the surgery, providing a better understanding of their culture and lifestyle expectations. The physician can enhance the discussion by providing decision aids, a video, pamphlet or web-based information that objectively provides patients with the risks and benefits of these treatment options. In order to maintain objectivity with evidence-based information, the International Patient Decision Aids Standards Collaboration and National Quality Forum have published criteria that should be considered when selecting aids to give to patients. Together, the patient and physician select the treatment plan that best aligns with the patient’s preferences.

“It’s important not to assume these discussions regularly occur, when in fact, a patient’s limited health literacy and cultural differences may stand in the way of SDM,” said Dr. Probe. “Decision aids, especially those written at various reading levels, can help reduce disparities in resource utilization among minorities, leading to a more informed conversation that takes into account cultural differences, religious beliefs and quality of life issues.”

Moving forward, Dr. Probe is optimistic that with increased awareness, orthopaedic surgeons can determine best practices for incorporating SDM into their workflows for patients who want to be involved in the decision-making process.

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[i] Charles C, Whelan T, Gafni A: What do we mean by partnership in making decisions about treatment? BMJ 1999;319:780-782.

[ii] Slover J, Shue J, Koenig K: Shared decision- making in orthopaedic surgery. Clin Orthop Relat Res 2012;470:1046-1053.

[iii] Klifto K, Klifto C, Slove J: Current concepts of shared decision making in orthopedic surgery. Curr Rev Musculoskelet Med 2017;10:253-257.

[iv] Deber RB, Kraetschmer N, Urowitz S, Sharpe N: Do people want to be autonomous patients? Preferred roles in treatment decision-making in several patient populations. Health Expect 2007; 10:248-258.

[v] Bozic KJ, Belkora J, Chan V, et al: Shared decision making in patients with osteoarthritis of the hip and knee: Results of a randomized controlled trial. J Bone Joint Surg Am 2013;95:1633-1639.

[vi] Sepucha KR, Atlas SJ, Chang Y, et al: Informed, patient-centered decisions associated with better health outcomes in orthopedics: prospective cohort study. Med Decis Making 2018;38: 1018-1026.