Assessing Practitioners’ and Patients’ Needs Regarding Shared Decision-Making and Decision Aids

Document Type : RESEARCH PAPER


1 Orthopaedic Hand and Upper Extremity Service, Yawkey Center, Massachusetts General Hospital, Boston, USA

2 Chief Orthopaedic Hand Service, Yawkey Center, Massachusetts General Hospital, 55 Fruit Street, Boston, USA

3 Abzug M. Joshua, Julie Adams, Gallo Fabio Arbelaez, T. Aspard, George W. Balfour, Brent H. Bamberger, Jose Camilo Barreto Romero, Michael Baskies, Arnnold W. Batson, Taizoon Baxamusa, Ramón De Bedout, Steven Beldner, Prosper Benhaim, Leon Benson, Jorge G. Boretto, Martin Boyer, Gregory Byrd Dee, Ryan P. Calfee, Cecilia Gladys Caro Zambrano, Charles Cassidy, Louis III Catalano, Karel Chivers, Ralph M. Costanzo, Phani Dantuluri, Gregory DeSilva, Seth Dodds, John P. Evans, Luis Felipe Náquira Escobar, C.H. Fernandes, Thomas J. Fischer, Jochen Fischer, Renato M. Fricker, Gary K. Frykman, Aida E. Garcia, Glenn R. Gaston, Fernando José Giovanni Di, Charles A. Goldfarb, Michael W. Grafe, H.W. Grunwald, Warren C. Hammert, Randy Hauck, Ricardo German Hernandez, Eric Hofmeister, Richard L. Hutchison, Asif Ilyas, Jonathan Isaacs, Sidney M. Jacoby, Peter Jebson, Christopher M. Jones, Michael Jones, Sanjeev Kakar, David M. Kalainov, Kaplan D. Thomas, Saul Kaplan, Leonid Katolik, Stephen A. Kennedy, Michael W. Kessler, Hervey L. Kimball, G.A. Kraan, Paul A. Martineau, John McAuliffe, Steven J. McCabe, Desirae M. McKee, Greg Merrell, Charles Metzger, Michael Nancollas, David L. Nelson, Ralf Nyszkiewicz, Jose A. Ortiz, Patrick W. Owens, Jason M. Palmer, Lior Paz, Gary M. Pess, Daniel Polatsch, J. Frank Raia, Marc J. Richard, Marco Rizzo, Rozental, David Ruchelsman, Oleg M. Semenkin, Javier Francisco Sierra Aguilar, Todd Siff, Samir Sodha, Catherine Spath, Sander Spruijt, Thomas G. Stackhouse, Carrie Swigart, Robert M. Szabo, John Taras, Jason D. Tavakolian, Andrew L. Terrono, Thomas F. Varecka, Abhijeet L. Wahegaonkar, Christopher J. Walsh, Frank L. Walter, Lawrence Weiss, Brian P.D Wills, Chris Wilson, Christopher J. Wilson, Jennifer Wolf Moriatis, Megan M. Wood, Colby Young.


 Background: As part of the process of developing a decision aid for carpal tunnel syndrome (CTS) according to the Ottawa Decision Support Framework, we were interested in the level of ‘decisional conflict’ of hand surgeons and patients with CTS. This study addresses the null hypothesis that there is no difference between surgeon and patient decisional conflict with respect to test and treatment options for CTS. Secondary analyses assess the impact of patient and physician demographics and the strength of the patient-physician relationship on decisional conflict.
Methods: One-hundred-twenty-three observers of the Science of Variation Group (SOVG) and 84 patients with carpal tunnel syndrome completed a survey regarding the Decisional Conflict Scale. Patients also filled out the Pain Self-efficacy Questionnaire (PSEQ) and the Patient Doctor Relationship Questionnaire (PDRQ-9).
Results: On average, patients had significantly greater decision conflict and scored higher on most subscales of the decisional conflict scale than hand surgeons.Factors associated with greater decision conflict were specific hand surgeon, less self-efficacy (confidence that one can achieve one’s goals in spite of pain), and higher PDRQ (relationship between patient and doctor). Surgeons from Europe have--on average--significantly more decision conflict than surgeons in the United States of America.
Conclusions: Patients with CTS have more decision conflict than hand surgeons. Decision aids might help narrow this gap in decisional conflict.


  1. Davis RE, Dolan G, Thomas S, Atwell C, Mead D, Nehammer S, et al. Exploring doctor and patient views about risk communication and shared decision-making in the consultation. Health Expect. 2003; 6(3):198-207.
  2. O’Connor AM. Validation of a decisional conflict scale. Med Decis Making. 1995; 15(1):25-30.
  3. Wennberg JE, Mulley AG Jr, Hanley D, Timothy RP, Fowler FJ Jr, Roos NP, et al. An assessment of prostatectomy for benign urinary tract obstruction. Geographic variations and the evaluation of medical care outcomes. JAMA. 1988; 259(20):3027-30.
  4. Shaw D, Elger B. Evidence-based persuasion: an ethical imperative. JAMA. 2013; 309(16):1689-90.
  5. O’Connor A. Ottawa decision support framework to address dicisional conflict. Available at: URL: http://decisionaidohrica/docs/develop/ODSFpdf; 2006.
  6. Van der Feltz-Cornelis CM, Van Oppen P, Van Marwijk HW, De Beurs E, Van Dyck R. A patient-doctor relationship questionnaire (PDRQ-9) in primary care: development and psychometric evaluation. Gen Hosp Psychiatry. 2004; 26(2):115-20.
  7. Asghari A, Nicholas MK. Pain self-efficacy beliefs and pain behaviour. A prospective study. Pain. 2001; 94(1):85-100.
  8. Nicholas MK. The pain self-efficacy questionnaire: Taking pain into account. Eur J Pain. 2007; 11(2):153-63.
  9. Stacey D, Bennett CL, Barry MJ, Col NF, Eden KB, Holmes-Rovner M, et al. Decision aids for people facing health treatment or screening decisions. Cochrane Database Syst Rev. 2011; 10(10):1-217.
  10. Goel V, Sawka CA, Thiel EC, Gort EH, O’Connor AM. Randomized trial of a patient decision aid for choice of surgical treatment for breast cancer. Med Decis Making. 2001; 21(1):1-6.
  11. Vandemheen KL, O’Connor A, Bell SC, Freitag A, Bye P, Jeanneret A, et al. Randomized trial of a decision aid for patients with cystic fibrosis considering lung transplantation. Am J Respir Crit Care Med. 2009; 180(8):761-8.
  12. Vodermaier A, Caspari C, Koehm J, Kahlert S, Ditsch N, Untch M. Contextual factors in shared decision making: a randomised controlled trial in women with a strong suspicion of breast cancer. Br J Cancer. 2009; 100(4):590-7.
  13. Whelan T, Levine M, Willan A, Gafni A, Sanders K, Mirsky D, et al. Effect of a decision aid on knowledge and treatment decision making for breast cancer surgery: a randomized trial. JAMA. 2004; 292(4):435-41.
  14. Adam JA, Khaw FM, Thomson RG, Gregg PJ, Llewellyn-Thomas HA. Patient decision aids in joint replacement surgery: a literature review and an opinion survey of consultant orthopaedic surgeons. Ann R Coll Surg Engl. 2008; 90(3):198-207.
  15. Phelan EA, Deyo RA, Cherkin DC, Weinstein JN, Ciol MA, Kreuter W, et al. Helping patients decide about back surgery: a randomized trial of an interactive video program. Spine. 2001; 26(2):206-11.
  16. Slover J, Shue J, Koenig K. Shared decision-making in orthopaedic surgery. Clin Orthop Relat Res. 2011; 470(4):1046-53.
  17. Vranceanu AM, Cooper C, Ring D. Integrating patient values into evidence-based practice: effective communication for shared decision-making. Hand Clin. 2009; 25(1):83-96.
  18. van Randenborgh A, de Jong-Meyer R, Huffmeier J. Decision making in depression: differences in decisional conflict between healthy and depressed individuals. Clin Psychol Psychother. 2010; 17(4):285-98.