Informed shared decision-making and patient satisfaction.
BACKGROUND
Evidence suggests that when patients have a role in medical decisions they are more satisfied with their health care.


OBJECTIVE
To assess predictors of patient satisfaction, ratings of the provider's informed shared decision-making (ISDM), and disability among patients with orthopedic pain complaints.


METHODS
A total of 130 patients with nontraumatic painful conditions of the upper extremity were enrolled. Medical encounters were audio recorded and coded by 2 independent coders. Eight ISDM elements and a total ISDM score were evaluated. Bivariate and multivariable analyses were used to answer the study questions.


METHODS
Participants completed the Princess Margaret Hospital Patient Satisfaction with their Doctor Questionnaire to measure satisfaction; the Disabilities of Arm, Shoulder and Hand questionnaire; the Patient Health Questionnaire-9 to measure depression; the Whiteley Index to assess heightened illness concerns; and the pain catastrophizing scale to assess coping strategies in response to pain.


RESULTS
Less health anxiety, female gender, the ISDM element Identify choice, and any specific diagnosis determined 22% of the variation in satisfaction. Less health anxiety and unemployed unable to work compared with full-time working status were associated with a better rating of shared decision-making on the ISDM. Catastrophic thinking, female gender, symptoms of depression, and any specific diagnosis were associated with greater disability. Catastrophic thinking and symptoms of depression were the greatest contributors to the variation in disability.


CONCLUSIONS
Psychologic factors are the strongest determinants of patient satisfaction, ratings of shared decision-making on the ISDM, and upper-extremity disability. Health anxiety is the most important factor in ratings of patient satisfaction and ISDM, whereas depression and catastrophizing are salient predictors of disability.


METHODS
Prognostic level I.
Orthopaedic Hand and Upper Extremity Service, Massachusetts General Hospital, Harvard Medical School, Boston, MA?>
Arjan G J
AG
Bot
Orthopaedic Hand and Upper Extremity Service, Massachusetts General Hospital, Harvard Medical School, Boston, MA?>
Jeroen K J
JK
Bossen
Orthopaedic Hand and Upper Extremity Service, Massachusetts General Hospital, Harvard Medical School, Boston, MA?>
James H
JH
Herndon
Orthopaedic Hand and Upper Extremity Service, Massachusetts General Hospital, Harvard Medical School, Boston, MA?>
David E
DE
Ruchelsman
Orthopaedic Hand and Upper Extremity Service, Massachusetts General Hospital, Harvard Medical School, Boston, MA?>. Electronic address: dring@partners.org.
David
D
Ring
Department of Behavioral Medicine, Benson Henry Mind Body Institute, Massachusetts General Hospital; Harvard Medical School, Boston, MA.
Ana-Maria
AM
Vranceanu
D000223:Adaptation, Psychological; D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001132:Arm; D058443:Catastrophization / Q000523:psychology; D003657:Decision Making; D003863:Depression / Q000523:psychology; D004185:Disability Evaluation; D005260:Female; D006225:Hand; D006801:Humans; D008297:Male; D008875:Middle Aged; D010146:Pain / Q000523:psychology; D017060:Patient Satisfaction; D020069:Shoulder Pain / Q000523:psychology; D011795:Surveys and Questionnaires; D055815:Young Adult