Shared Decision Making in Orthopaedic Surgery: More Than Two to Tango?

Abstract

Orthopaedic surgeons have had relatively little exposure to shared decision-making tools in their practice. First popularized in a 1982 report issued by the President’s Commission for the Study of Ethical Problems in Medicine and Biomedical and Behavioral Research1, shared decision making is generally viewed as an embodiment of the principle of patient-centered care, with shared decisions between patients and providers often facilitated by decision and communication aids. Charles et al.2 identified the characteristics of shared decision making as involving the patient and provider, both parties participating in the treatment decision-making process, requiring information sharing, and both parties agreeing to the treatment decision made, with the recognition that many of these characteristics are continuous variables. The authors of the present study have previously made important contributions to our understanding of how shared decision making might be incorporated into orthopaedic practice, with both attendant benefits and obstacles to overcome3,4. Knee and hip osteoarthritis treatment includes both medical and surgical interventions often managed by orthopaedists, and when pain and disability are unresponsive to medical treatment, total joint arthroplasty is frequently recommended. Total joint arthroplasty is appropriately viewed as a preference-sensitive procedure, as the indications are driven by the patients’ perception of pain, …