"Surgery Is Certainly One Good Option": Quality and Time-Efficiency of Informed Decision-Making in Surgery

Braddock, III, Clarence; Hudak, Pamela L.; Feldman, Jacob J.; Bereknyei, Sylvia; Frankel, Richard M.; Levinson, Wendy
September 2008
Journal of Bone & Joint Surgery, American Volume;Sep2008, Vol. 90-A Issue 9, p1830
Academic Journal
Background: Informed decision-making has been widely promoted in several medical settings, but little is known about the actual practice in orthopaedic surgery and there are no clear guidelines on how to improve the process in this setting. This study was designed to explore the quality of informed decision-making in orthopaedic practice and to identify excellent time-efficient examples with older patients. Methods: We recruited orthopaedic surgeons, and patients sixtyyears of age or older, in a Midwestern metropolitan area for a descriptive study performed through the analysis of audiotaped physician-patient interviews. We used a valid and reliable measure to assess the elements of informed decision-making. These included discussions of the nature of the decision, the patient's role, alternatives, pros and cons, and uncertainties; assessment of the patient's understanding and his or her desire to receive input from others; and exploration of the patient's preferences and the impact on the patient's daily life. The audiotapes were scored with regard to whether there was a complete discussion of each informed-decision-making element (an IDM-18 score of 2) or a partial discussion of each element (an IDM-18 score of 1) as well as with a more pragmatic metric (the IDM-Mm score), reflecting whether there was any discussion of the patient's role or preference and of the nature of the decision. The visit duration was studied in relation to the extent of the informed decision-making, and excellent time-efficient examples were sought. Results: There were 141 informed-decision-making discussions about surgery, including knee and hip replacement as well as wrist/hand, shoulder, and arthroscopic surgery. Surgeons frequently discussed the nature of the decision (92% of the time), alternatives (62%), and risks and benefits (59%); they rarely discussed the patient's role (14%) or assessed the patient's understanding (12%). The IDM-18 scores of the 141 discussions averaged 5.9 (range, 0 to 15; 95% confidence interval, 5.4 to 6.5). Fifty-seven percent of the discussions met the IDM-Mm criteria. The median duration of the visits was sixteen minutes; the extent of informed decision-making had only a modest relationship with the visit duration. Time-efficient strategies that were identified included use of scenarios to illustrate distinct choices, encouraging patient input, and addressing primary concerns rather than lengthy recitations of pros and cons. Conclusions: In this study, which we believe is the first to focus on informed decision-making in orthopaedic surgical practice, we found opportunities for improvement but we also found that excellent informed decision-making is feasible and can be accomplished in a time-efficient manner.


Related Articles

  • Multiattribute Structure for QALYs. Hazen, Gordon // Decision Analysis;Dec2004, Vol. 1 Issue 4, p205 

    Health status is inherently a multiattribute construct. We examine multiattribute utility decompositions for the quality-adjusted life year (QALY) utility model commonly employed in medical decision and cost-effectiveness analyses. We consider several independence conditions on preference,...

  • Multiplicative Utilities for Health and Consumption. Lichtendahl Jr., Kenneth C.; Bodily, Samuel E. // Decision Analysis;Dec2012, Vol. 9 Issue 4, p314 

    Many challenging medical/financial decisions require a decision maker to express preferences for lifetime streams of health and consumption. To express such preferences, we develop two multiplicative utility forms from basic conditions. These forms have many advantages over the leading additive...

  • Stochastic dominance in multicriterion analysis under risk. Martel, Jean-Marc; Zaras, Kazimierz // Theory & Decision;Jul95, Vol. 39 Issue 1, p31 

    Proposes a multiattribute decision aid model, based on stochastic dominance results which is used to build outranking relations which consider the possibility of incomparability. Formulation of the problem; Partial preferences between two alternatives under risk; Synthetical outranking relation...

  • Evaluating Clinical Decision Support Systems: Monitoring CPOE Order Check Override Rates in the Department of Veterans Affairs' Computerized Patient Record System. CHING-PING LIN; PAYNE, THOMAS H.; NICHOL, W. PAUL; HOEY, PATRICIA J.; ANDERSON, CURTIS L.; GENNARI, JOHN H. // Journal of the American Medical Informatics Association;Sep/Oct2008, Vol. 15 Issue 5, p620 

    Objective: To measure critical order check override rates in VA Puget Sound Health Care System's computerized practitioner order entry (CPOE) system and to compare 2006 results to a similar 2001 study. Design: Analysis of ordering and order check data gathered by a post-hoc logging program. Use...

  • Probability Adjusted Financial Impact Analysis: Part 1. Tarantino, David P. // Physician Executive;Jan/Feb2008, Vol. 34 Issue 1, p83 

    The article focuses on the evaluation methods used by the Mid-Atlantic Hospital Center in the U.S. in selecting an electronic medical record (EMR) system. It cites that before choosing an EMR system, the task force assigned for the evaluation process has determined key criteria including...

  • Indications for Molar Tooth Resection: Hemisection versus Root Amputation. Cambra, Jordi; Zabelegui, Borja // Critical Decisions in Periodontology;2003, p144 

    Chapter 72 of the book "Critical Decisions in Periodontology" is presented. It explores the practice of periodontics particularly the indications for molar tooth resection through hemisection or root amputation. It describes common clinical problems and how practitioners decide on what should be...

  • ERRATUM.  // Technological & Economic Development of Economy;2013, Vol. 19 Issue 1, pIa 

    No abstract available.

  • Regional variation in nonmedical factors affecting family physicians' decisions about referral for c Langley, G. Ross; Minkin, Salomon // CMAJ: Canadian Medical Association Journal;08/01/97, Vol. 157 Issue 3, p265 

    Presents a study in Nova Scotia to determine if family physicians' referral decisions are affected by regional variation in environmental or non-medical factors. The design of the study; Setting; Participants; Outcome measures; Results; Conclusions.

  • On the number of criteria needed to decide Pareto optimality. Ehrgott, Matthias; Nickel, Stefan // Mathematical Methods of Operations Research;2002, Vol. 55 Issue 3, p329 

    In this paper we address the question of how many objective functions are needed to decide whether a given point is a Pareto optimal solution for a multicriteria optimization problem. We extend earlier results showing that the set of weakly Pareto optimal points is the union of Pareto optimal...


Read the Article


Sorry, but this item is not currently available from your library.

Try another library?
Sign out of this library

Other Topics