title: Preferences for Shared Decision Making in Older Adult Patients With Orthopedic Hand Conditions.
abstract: OBJECTIVE
  The practice of medicine is shifting from a paternalistic doctor-patient relationship to a model in which the doctor and patient collaborate to decide optimal treatment. This study aims to determine whether the older orthopedic population desires a shared decision-making approach to care and to identify patient predictors for the preferred type of approach.
  
  
  METHODS
  This cross-sectional investigation enrolled 99 patients, minimum age 65 years, at a tertiary hand specialty practice between March and June 2015. All patients completed the Control Preferences Scale, a validated system that distinguishes among patient preferences for patient-directed, collaborative, or physician-directed decision making. Bivariate and logistic regression analyses assessed associations among demographic data; clinic encounter variables such as familiarity with provider, trauma, diagnosis, and treatment decision; and the primary outcome of Control Preferences Scale preferences.
  
  
  RESULTS
  A total of 81% of patients analyzed preferred a more patient-directed role in decision making; 46% of the total cohort cited a collaborative approach as their most preferred treatment approach. Sixty-seven percent cited the most physician-directed approach as their least preferred model of decision making. In addition, 49% reported that spending more time with their physician to address questions and explain the diagnosis would be most useful when making a health care decision and 73% preferred additional written informational material. Familiarity with the provider was associated with being more likely to prefer a collaborative approach.
  
  
  CONCLUSIONS
  Older adult patients with symptomatic upper-extremity conditions desire more patient-directed roles in treatment decision making. Given the limited amount of reliable information obtained independently outside the office visit, our data suggest that written decision aids offer an approach to shared decision making that is most consistent with the preferences of the older orthopedic patient.
  
  
  CONCLUSIONS
  This study quantifies older adults' desire to participate in decision making when choosing among treatments for hand conditions.
authors.affiliation: Department of Orthopedic Surgery, Washington University School of Medicine, St. Louis, MO.
authors.forename: Agnes Z
authors.initials: AZ
authors.lastname: Dardas
authors.affiliation: Department of Orthopedic Surgery, Washington University School of Medicine, St. Louis, MO.
authors.forename: Christopher
authors.initials: C
authors.lastname: Stockburger
authors.affiliation: Department of Orthopedic Surgery, Washington University School of Medicine, St. Louis, MO.
authors.forename: Sean
authors.initials: S
authors.lastname: Boone
authors.affiliation: Department of Orthopedic Surgery, Washington University School of Medicine, St. Louis, MO.
authors.forename: Tonya
authors.initials: T
authors.lastname: An
authors.affiliation: Department of Orthopedic Surgery, Washington University School of Medicine, St. Louis, MO. Electronic address: camdene@wudosis.wustl.edu.
authors.forename: Ryan P
authors.initials: RP
authors.lastname: Calfee
mesh_terms: D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D003430:Cross-Sectional Studies; D003657:Decision Making; D005260:Female; D015577:Geriatric Assessment / Q000379:methods; D006225:Hand / Q000503:physiopathology* / Q000601:surgery*; D006801:Humans; D016015:Logistic Models; D008297:Male; D015999:Multivariate Analysis; D019637:Orthopedic Procedures / Q000379:methods*; D010358:Patient Participation / Q000706:statistics & numerical data; D057240:Patient Preference; D010817:Physician-Patient Relations; D011788:Quality of Life; D012189:Retrospective Studies; D018570:Risk Assessment; D016896:Treatment Outcome
keywords: Control Preferences Scale; elderly; hand; older; shared decision making