Abstract
Background: Few studies have addressed patient preferences in emergent surgical decision making. Aim of the study: Analyzing patient preferences for hand trauma reconstruction to propose a decision-making model. Methods: A conjoint analysis survey was developed with Sawtooth Software. Three common flaps—i.e., a cross-finger flap (CFF), a dorsal metacarpal artery perforator flap (DMAPF), and an arterialized venous flap (AVF)—were listed as treatment alternatives. Five attributes corresponding to these flaps were recovery time, total procedure, postoperative care methods, postoperative scar condition, and complication rate. Utility and importance scores were generated from the software, and preference characteristics were evaluated using cluster analysis. Results: The survey was completed by 197 participants with hand trauma. Complication risk received the highest importance score (42.87%), followed by scar condition (21.55%). Cluster analysis classified the participants as “conservative,” “practical,” and “dual-concern”. The dual-concern and conservative groups had more foreign laborers and highly educated participants, respectively, than the other groups. Most participants in the conservative and practical groups preferred DMAPF, whereas those in the dual-concern group favored CFF. Our proposed model consisted of shared decision-making and treatment recommendation pathways. Conclusion: Incorporating patient preferences into the decision-making model can strengthen patient-centered care. Further research on the applications of the proposed model is warranted.
Highlights
The trend of medical decision making has changed from passive informed consent to shared decision making (SDM)
Owing to the fact that real-world decision making pertaining to the treatment of patients with hand trauma usually occurs in the emergency room (ER), conducting a survey is often difficult in such a chaotic environment
We found that complication risk had the greatest influence on flap selection, followed by scar condition
Summary
Surgical decision making has historically been based on existing guidelines, personal experiences, and recommendations with the application of surgical basic sciences. Many factors may affect decisions, including clinical states, healthcare resources, surgeons’. Expertise, and patient preferences [1]. Patient-centered care has become a central value in healthcare systems, and this represents a shift in the traditional roles of patients and their families, from only taking orders to becoming team participants. Few studies have addressed patient preferences in emergent surgical decision making. Aim of the study: Analyzing patient preferences for hand trauma reconstruction to propose a decision-making model. Methods: A conjoint analysis survey was developed with Sawtooth. Five attributes corresponding to these flaps were recovery time, total procedure, postoperative care methods, postoperative scar condition, and complication rate. Utility and importance scores were generated from the software, and preference characteristics were evaluated using cluster analysis
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