Abstract: Patient Preferences in the Management of Acute Non-Displaced or Minimally Displaced Scaphoid Fractures: A Conjoint Analysis

Abstract

INTRODUCTION: We hypothesized that out-of-pocket costs would have a greater influence on patient decision making for operative or non-operative management of a scaphoid fracture when compared to the time spent in a cast or brace, degree of soreness, or the risk of treatment failure. METHODS: Survey participants were recruited using Amazon Mechanical Turk. A conjoint preference experiment derived the relative importance of attributes thought to be influential in the decision to undergo operative or non-operative management of a scaphoid fracture. The attributes described were time in a cast, time in a brace, remaining soreness/stiffness, risk of treatment failure, and cost. Respondents chose among 13 different alternatives that differed in these attributes. Survey respondents were then asked to choose between operative or non-operative management. RESULTS: A total of 250 people participated in this survey. The most important factors in respondent decision-making were cost, followed by time spent in a cast and risk of treatment failure. Time spent in a brace and remaining soreness or stiffness were less important. The relative importance of these attributes was used in conjunction with a 5-point scale that assessed the respondents’ apprehension to undergo surgery. This allowed for a prediction to be made about the type of management the respondent would choose to undergo; and in conjunction with a sensitivity analysis, the proportion of respondents who would choose operative management given different outcomes (i.e. higher cost, higher risk of treatment failure, etc.) was estimated. Overall, 37% of respondents chose operative management. Instead of paying $500, people would rather experience two weeks in a cast, three weeks in a brace, two months of soreness, or a 2% increase in the risk of treatment failure. A one point decrease in an individual’s apprehension about surgery has the same impact on treatment selection as a $600 reduction in the cost of surgery. Individuals who have undergone surgery in the past, and those with a higher level of education, were less apprehensive about surgery. CONCLUSION: Cost and apprehension about surgery are important factors in patient decision making for the treatment of scaphoid fractures. Surgeons should address these concerns with patients while discussing the treatment options for their injury.