title: Shared decision-making in orthopaedic surgery.
abstract: BACKGROUND
  The process of clinical decision-making and the patient-physician relationship continue to evolve. Increasing patient involvement in clinical decision-making is embodied in the concept of "shared decision-making" (SDM), in which the patient and physician share responsibility in the clinical decision-making process. Various patients' decision aid tools have been developed to enhance this process.
  
  
  OBJECTIVE
  We therefore (1) describe decision-making models; (2) discuss the different types of patients' decision aids available to practice SDM; and (3) describe the practice and early impact of SDM on clinical orthopaedic surgery.
  
  
  METHODS
  We performed a search of the literature using PubMed/MEDLINE and Cochrane Library. We identified studies related to shared decision-making and the use of patients' decision aids in orthopaedics. The search resulted in 113 titles, of which 21 were included with seven studies on patients' decision aid use specifically in orthopaedics.
  
  
  RESULTS
  Although limited studies suggest the use of patients' decision aids may enhance decision-making, conclusions about the use of these aids in orthopaedic clinical practice cannot be made and further research examining the best type, timing, and content of patients' decision aids that will lead to maximum patient involvement and knowledge gains with minimal clinical workflow interruption are needed.
  
  
  CONCLUSIONS
  In clinical practice today, patients are increasingly involved in clinical decision-making. Further research on SDM in orthopaedic surgery examining the feasibility and impact on practice, on patients' willingness and ability to actively participate in shared decision-making, and the timing and type of patients' decision aids appropriate for use is still needed.
authors: Department of Orthopaedic Surgery, NYU Hospital for Joint Diseases, 301 East 17th Street, Suite 1616, New York, NY 10003, USA. James.Slover@nyumc.org
authors: James
authors: J
authors: Slover
authors: Jennifer
authors: J
authors: Shue
authors: Karl
authors: K
authors: Koenig
mesh_terms: D001291:Attitude of Health Personnel; D003657:Decision Making; D003661:Decision Support Techniques; D006301:Health Services Needs and Demand; D006801:Humans; D019637:Orthopedic Procedures; D010358:Patient Participation; D010817:Physician-Patient Relations