title: Do Upper Extremity Trauma Patients Have Different Preferences for Shared Decision-making Than Patients With Nontraumatic Conditions?
abstract: BACKGROUND
  Shared decision-making is a combination of expertise, available scientific evidence, and the preferences of the patient and surgeon. Some surgeons contend that patients are less capable of participating in decisions about traumatic conditions than nontraumatic conditions.
  
  
  OBJECTIVE
  (1) Do patients with nontraumatic conditions have different preferences for shared decision-making when compared with those who sustained acute trauma? (2) Do disability, symptoms of depression, and self-efficacy correlate with preference for shared decision-making?
  
  
  METHODS
  In this prospective, comparative trial, we evaluated a total of 133 patients presenting to the outpatient practices of two university-based hand surgeons with traumatic or nontraumatic hand and upper extremity illnesses or conditions. Each patient completed questionnaires measuring their preferred role in healthcare decision-making (Control Preferences Scale [CPS]), symptoms of depression (Patients' Health Questionnaire), and pain self-efficacy (confidence that one can achieve one's goals despite pain; measured using the Pain Self-efficacy Questionnaire). Patients also completed a short version of the Disabilities of the Arm, Shoulder, and Hand questionnaire and an ordinal rating of pain intensity.
  
  
  RESULTS
  There was no difference in decision-making preferences between patients with traumatic (CPS: 3 ± 2) and nontraumatic conditions (CPS: 3 ± 1 mean difference = 0.2 [95% confidence interval, -0.4 to 0.7], p = 0.78) with most patients (95 versus 38) preferring shared decision-making. More educated patients preferred a more active role in decision-making (beta = -0.1, r = 0.08, p = 0.001); however, differences in levels of disability, pain and function, depression, and pain-related self-efficacy were not associated with differences in patients' preferences in terms of shared decision-making.
  
  
  CONCLUSIONS
  Patients who sustained trauma have on average the same preference for shared decision-making compared with patients who sustained no trauma. Now that we know the findings of this study, clinicians might be motivated to share their expertise about the treatment options, potential outcomes, benefits, and harms with the patient and to discuss their preference as well in a semiacute setting, resulting in a shared decision.
authors.affiliation: Orthopaedic Hand and Upper Extremity Service, Massachusetts General Hospital, 55 Fruit Street, Boston, MA, 02114, USA.
authors.forename: Michiel G J S
authors.initials: MG
authors.lastname: Hageman
authors.affiliation: Orthopaedic Hand and Upper Extremity Service, Massachusetts General Hospital, 55 Fruit Street, Boston, MA, 02114, USA.
authors.forename: Rajesh
authors.initials: R
authors.lastname: Reddy
authors.affiliation: Orthopaedic Hand and Upper Extremity Service, Massachusetts General Hospital, 55 Fruit Street, Boston, MA, 02114, USA.
authors.forename: Dennis J S
authors.initials: DJ
authors.lastname: Makarawung
authors.affiliation: Orthopaedic Hand and Upper Extremity Service, Massachusetts General Hospital, 55 Fruit Street, Boston, MA, 02114, USA.
authors.forename: Jan Paul
authors.initials: JP
authors.lastname: Briet
authors.affiliation: Academic Medical Center, Amsterdam, The Netherlands.
authors.forename: C Niek
authors.initials: CN
authors.lastname: van Dijk
authors.affiliation: Orthopaedic Hand and Upper Extremity Service, Massachusetts General Hospital, 55 Fruit Street, Boston, MA, 02114, USA. dring@mgh.harvard.edu.
authors.forename: David
authors.initials: D
authors.lastname: Ring
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003657:Decision Making; D003863:Depression / Q000175:diagnosis / Q000523:psychology; D004185:Disability Evaluation; D005260:Female; D006230:Hand Injuries / Q000175:diagnosis / Q000523:psychology / Q000628:therapy; D015438:Health Behavior; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D008297:Male; D008875:Middle Aged; D059352:Musculoskeletal Pain / Q000175:diagnosis / Q000523:psychology* / Q000628:therapy; D010147:Pain Measurement; D010353:Patient Education as Topic; D010358:Patient Participation; D010361:Patients / Q000523:psychology*; D011446:Prospective Studies; D020377:Self Efficacy; D011795:Surveys and Questionnaires; D034941:Upper Extremity / Q000293:injuries*; D014947:Wounds and Injuries / Q000175:diagnosis / Q000523:psychology* / Q000628:therapy; D055815:Young Adult