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Informed, Patient-Centered Decisions Associated with Better Health Outcomes in Orthopedics: Prospective Cohort Study

Author

Listed:
  • Karen R. Sepucha
  • Steven J. Atlas
  • Yuchiao Chang
  • Andrew Freiberg
  • Henrik Malchau
  • Mahima Mangla
  • Harry Rubash
  • Leigh H. Simmons
  • Thomas Cha

Abstract

Background . A goal of shared decision making (SDM) is to ensure patients are well informed and receive preferred treatments. However, the relationship between SDM and health outcomes is not clear. Objective . The purpose was to examine whether patients who are well informed and receive their preferred treatment have better health outcomes. Design, Setting, and Participants . A prospective cohort study at an academic medical center surveyed new patients with knee or hip osteoarthritis, herniated disc, or spinal stenosis 1 week after seeing a specialist and again 6 months later. Main Outcomes and Measures . The survey assessed knowledge, preferred treatment, and quality of life (QoL). The percentage of patients who were well informed and received preferred treatment was calculated (informed, patient centered [IPC]). A follow-up survey assessed QoL, decision regret, and satisfaction. Regression analyses with generalized estimating equations to account for clustering tested a priori hypotheses that patients who made IPC decisions would have higher QoL. Results . Response rate was 70.3% (652/926) for initial and 85% (551/648) for follow-up. The sample was 63.9 years old, 52.8% were female, 62.6% were college educated, and 49% had surgery. One-third (37.4%) made IPC decisions. Participants who made IPC decisions had significantly better overall (0.05 points (SE 0.02) for EQ-5D, P = 0.004) and disease-specific quality of life (4.22 points [SE 1.82] for knee, P = 0.02; 4.46 points [SE 1.54] for hip, P = 0.004; and 6.01 points [SE 1.51] for back, P

Suggested Citation

  • Karen R. Sepucha & Steven J. Atlas & Yuchiao Chang & Andrew Freiberg & Henrik Malchau & Mahima Mangla & Harry Rubash & Leigh H. Simmons & Thomas Cha, 2018. "Informed, Patient-Centered Decisions Associated with Better Health Outcomes in Orthopedics: Prospective Cohort Study," Medical Decision Making, , vol. 38(8), pages 1018-1026, November.
    • Handle: RePEc:sae:medema:v:38:y:2018:i:8:p:1018-1026
    DOI: 10.1177/0272989X18801308
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    References listed on IDEAS

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    1. John M Kelley & Gordon Kraft-Todd & Lidia Schapira & Joe Kossowsky & Helen Riess, 2014. "The Influence of the Patient-Clinician Relationship on Healthcare Outcomes: A Systematic Review and Meta-Analysis of Randomized Controlled Trials," PLOS ONE, Public Library of Science, vol. 9(4), pages 1-7, April.
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    Cited by:

    1. Karina Dahl Steffensen, 2019. "The promise of shared decision making in healthcare," AMS Review, Springer;Academy of Marketing Science, vol. 9(1), pages 105-109, June.

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