The Association Between Patient-Reported Outcome Measurement Scores and Preference for Specific Interventions.

Emily Z Boersma,John Mcdonald,Matt Driscoll,Joost T P Kortlever,Michael D Loeb,Gregg A Vagner,David Ring

doi:10.1177/2374373519897761

Abstract

To determine whether greater patient-reported symptom intensity and functional limitation influence expressed preferences for discretionary diagnostic and treatment interventions, we studied the association of patient factors and several Patient Reported Outcome Measure (PROM) scores with patient preferences for diagnostic and treatment interventions before and after the visit, a cross-sectional cohort study. One hundred and forty-three adult patients who completed several PROMs were asked their preferences for diagnostic and treatment interventions before and after a visit with an orthopedic surgeon. Patients with better physical function had fewer preferences for specific diagnostic interventions after the visit (P = .02), but PROM scores had no association with preferences for treatment interventions before or after the visit. A greater percentage of patients expressed the preference for no diagnostic or treatment intervention after the visit with a physician than before (diagnostic intervention; 2.1% before vs 30% after the visit; P ≤ .001 and treatment intervention; 2.1% before vs 17% after the visit; P ≤ .001). This study suggests that physician expertise may be more reassuring to people with more adaptive mind sets.

Highlights

Surgeons often encounter patients who bring specific diagnostic or treatment preferences to an initial visit
Accounting for potential interaction of variables using multivariable analysis, less preference for a diagnostic intervention after the visit was independently associated with better Physical Function (PF), that is, higher Patient-Reported Outcomes Measurement Information System (PROMIS) PF scores
Accounting for potential interaction of variables using multivariable analysis, preference for a treatment intervention before the visit was independently associated with gender, with less preference for men

Summary

Introduction

Surgeons often encounter patients who bring specific diagnostic or treatment preferences to an initial visit. Prior studies suggest about one-third of patients arrive with a selfdiagnosis prior to seeing the hand surgeon [1]. This might contribute to a stronger preference for a specific diagnostic or treatment intervention. There is some evidence that a preference for intervention might reflect less effective coping strategies, which are often related to stress and distress. Patients with less effective coping strategies may be more likely to choose surgery [2]. Surgeons should strive to help patients make the best treatment decisions for themselves based on the best available evidence and their personal values, unhindered by misconceptions and preexisting bias [3]

Methods

Results

Discussion

Conclusion