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Shared Decision-Making in the Management of Congenital Vascular Malformations

Horbach, Sophie E. R. M.D.; Ubbink, Dirk T. M.D., Ph.D.; Stubenrouch, Fabienne E. B.Sc.; Koelemay, Mark J. W. M.D., Ph.D.; van der Vleuten, Carine J. M. M.D., Ph.D.; Verhoeven, Bas H. M.D., Ph.D.; Reekers, Jim A. M.D., Ph.D.; Schultze Kool, Leo J. M.D., Ph.D.; van der Horst, Chantal M. A. M. M.D., Ph.D.

Plastic & Reconstructive Surgery: March 2017 - Volume 139 - Issue 3 - p 725e–734e
doi: 10.1097/PRS.0000000000003083
Pediatric/Craniofacial: Original Articles

Background: In shared decision-making, clinicians and patients arrive at a joint treatment decision, by incorporating best available evidence and the patients’ personal values and preferences. Little is known about the role of shared decision-making in managing patients with congenital vascular malformations, for which preference-sensitive decision-making seems obvious. The authors investigated preferences regarding decision-making and current shared decision-making behavior during physician-patient encounters.

Methods: In two Dutch university hospitals, adults and children with congenital vascular malformations facing a treatment-related decision were enrolled. Before the consultation, patients (or parents of children) expressed their preference regarding decision-making (Control Preferences Scale). Afterward, participants completed shared decision-making–specific questionnaires (nine-item Shared Decision-Making Questionnaire, CollaboRATE, and satisfaction), and physicians completed the Shared Decision-Making Questionnaire–Physician questionnaire. Consultations were audiotaped and patient involvement was scored by two independent researchers using the five-item Observing Patient Involvement instrument. All questionnaire results were expressed on a scale of 0 to 100 (optimum shared decision-making).

Results: Fifty-five participants (24 parents and 31 adult patients) were included. Two-thirds preferred the shared decision-making approach (Control Preferences Scale). Objective five-item Observing Patient Involvement scores were low (mean ± SD, 31 ± 15), whereas patient and physician Shared Decision-Making Questionnaire scores were high, with means of 68 ± 18 and 68 ± 19, respectively. The median CollaboRATE score was 93. There was no clear relationship between shared decision-making and satisfaction scores.

Conclusions: Although adults and parents of children with vascular malformations express a strong desire for shared decision-making, objective shared decision-making behavior is still lacking, most likely because of poor awareness of the shared decision-making concept among patients, parents, and physicians. To improve shared decision-making practice, targeted interventions (e.g., decision aids, staff training) are essential.

Amsterdam and Nijmegen, The Netherlands

From the Department of Plastic, Reconstructive, and Hand Surgery, the Department of Surgery, and the Department of Radiology, Division of Interventional Radiology, Academic Medical Center; and the Department of Dermatology, the Department of Surgery, and the Department of Radiology, Division of Interventional Radiology, Radboud University Medical Center.

Received for publication April 6, 2016; accepted June 27, 2016.

Disclosure: The authors have no financial relationships relevant to this article to disclose.

Sophie E. R. Horbach, M.D., Department of Plastic, Reconstructive and Hand Surgery, Academic Medical Center, P.O. Box 22660, 1100 DD, Amsterdam, The Netherlands, s.e.horbach@amc.uva.nl

©2017American Society of Plastic Surgeons