TY - JOUR ID - 11654 TI - Do Patient Preferences Influence Surgeon Recommendations for Treatment? JO - The Archives of Bone and Joint Surgery JA - ABJS LA - en SN - 2345-4644 AU - Smits, Lisanne J. H. AU - Wilkens, Suzanne C. AU - Ring, David AU - Guitton, Thierry G. AU - Chen, Neal C. AD - Department of Orthopaedic Surgery, Hand and Upper Extremity Service, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA AD - Department of Surgery and Perioperative Care, Dell Medical School at the University of Texas at Austin, Austin, Texas, USA AD - Department of Plastic Surgery, University Medical Center Groningen, Groningen, The Netherlands Y1 - 2019 PY - 2019 VL - 7 IS - 2 SP - 118 EP - 135 KW - conservative treatment KW - decision making KW - Patient preference KW - Surgery DO - 10.22038/abjs.2018.32214.1853 N2 - Background: When the best treatment option is uncertain, a patient’s preference based on personal values should bethe source of most variation in diagnostic and therapeutic interventions. Unexplained surgeon-to-surgeon variation intreatment for hand and upper extremity conditions suggests that surgeon preferences have more influence than patientpreferences.Methods: A total of 184 surgeons reviewed 18 fictional scenarios of upper extremity conditions for which operativetreatment 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 anaffirmative or negative manner. Surgeon characteristics were collected for each participant.Results: Of the six preferences studied, four influenced surgeon recommendations. Surgeons were more likelyto 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 patientsonly 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 recommendationsthough not as much as we expected-and surgeons on average interpreted surgery as more aesthetic. This emphasizesthe importance of strategies to help patients reflect on their values and ensure their preferences are consistent withthose values (e.g. use of decision-aids).Level of evidence: III UR - https://abjs.mums.ac.ir/article_11654.html L1 - https://abjs.mums.ac.ir/article_11654_5d068eb69a6b9a539406a0281f77fd98.pdf ER -