Patients Who Have Undergone Total Shoulder Arthroplasty Prefer Greater Surgeon Involvement in Shared Decision-Making.

Abstract

There has been a shift in medical decision making from a paternalist model to a shared decision-making (SDM) approach, described as a patient-physician relationship where both parties collaborate to arrive on an evidence-based treatment regimen that best suits the patient's needs and values. However, there is a paucity in evidence regarding SDM in shoulder arthroplasty. The purpose of this study was to evaluate overall patient preference for SDM and determine demographic and socioeconomic factors related to SDM preference in those undergoing shoulder arthroplasty. Patients aged 40 to 89 years who had undergone a total shoulder arthroplasty were enrolled. Two-part questionnaires were administered collecting patient demographic information and SDM subscale scores postoperatively. Bivariate and multivariate regression models were used to determine factors associated with SDM Total and subscale scores. A total of 125 patients (53 male; mean age, 69.5 ±10.4 years) who had undergone primary total shoulder arthroplasty were included. The mean Total SDM score was -2.24±1.9. and the Preoperative, Operative and Postoperative SDM subscale scores were -1.54±2.0, -2.59±2.2 and -2.48±2.1, respectively, indicating a preference for SDM in the Preoperative subscale and surgeon-driven decision making in the total score and other two subscales. Multivariate regression models demonstrated a preference for surgeon decision making at both the 4-12-week postoperative period for the Preoperative subscale (OR -1.03, 95% CI -2.0 - -0.1, p = 0.039) and the 2-4-week postoperative period for the Operative subscale (OR -1.74, 95% CI -3.4 - -0.1, p = 0.038) when compared to patients at the 2-week postoperative period. No other variables were significantly associated with any of the SDM subscale scores or Total SDM score. Patients reported a more passive role in the decision-making process with an overall preference for a surgeon-led approach in primary total shoulder arthroplasty. Patients preferred a shared decision-making approach in regard to preoperative considerations, but indicated a significant preference for surgeon-led decision-making regarding day of surgery decisions. There were no correlations between SDM scores and age, sex, race, income, education level, insurance type or treating surgeon. Overall, patients demonstrated a predilection for a SDM approach for preoperative considerations, contrary to those decisions associated with the day of surgery and postoperative care.