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Patient Preferences for Shared Decision Making

Not All Decisions Should Be Shared

E. Lindsay, Sarah BS; Alokozai, Aaron BS; Eppler, Sara L. MPH; Fox, Paige MD, PhD; Curtin, Catherine MD; Gardner, Michael MD; Avedian, Raffi MD; Palanca, Ariel MD; Abrams, Geoffrey D. MD; Cheng, Ivan MD; Kamal, Robin N. MD VOICES Health Policy Research Investigators:

Journal of the American Academy of Orthopaedic Surgeons: September 25, 2019 - Volume Publish Ahead of Print - Issue - p
doi: 10.5435/JAAOS-D-19-00146
Research Article: PDF Only

Introduction: To assess bounds of shared decision making in orthopaedic surgery, we conducted an exploratory study to examine the extent to which patients want to be involved in decision making in the management of a musculoskeletal condition.

Methods: One hundred fifteen patients at an orthopaedic surgery clinic were asked to rate preferred level of involvement in 25 common theoretical clinical decisions (passive [0], semipassive [1 to 4], equally shared involvement between patient and surgeon [5], semiactive [6 to 9], active [10]).

Results: Patients preferred semipassive roles in 92% of decisions assessed. Patients wanted to be most involved in scheduling surgical treatments (4.75 ± 2.65) and least involved in determining incision sizes (1.13 ± 1.98). No difference exists in desired decision-making responsibility between patients who had undergone orthopaedic surgery previously and those who had not. Younger and educated patients preferred more decision-making responsibility. Those with Medicare desired more passive roles.

Discussion: Despite the importance of shared decision making on delivering patient-centered care, our results suggest that patients do not prefer to share all decisions.

From the Department of Orthopaedic Surgery, Stanford University, Redwood City, CA.

Correspondence to Dr. Kamal:

None of the following authors or any immediate family member has received anything of value from or has stock or stock options held in a commercial company or institution related directly or indirectly to the subject of this article: Ms. Lindsay, Mr. Alokozai, Ms. Eppler, Dr. Fox, Dr. Curtin, Dr. Gardner, Dr. Avedian, Dr. Palanca, Dr. Abrams, Dr. Cheng, and Dr. Kamal.

Supplemental digital content is available for this article. Direct URL citation appears in the printed text and is provided in the HTML and PDF versions of this article on the journal's Web site (

All ICMJE Conflict of Interest Forms for authors and JAAOS editors and board members are on file with the publication and can be viewed on request.

Each author certifies that his or her institution approved the human protocol for this investigation, that all investigations were conducted in conformity with ethical principles of research, and that informed consent for participation in the study was obtained.

© 2019 by American Academy of Orthopaedic Surgeons
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