title: Shared decision making in the management of midshaft clavicular fractures: Nonoperative treatment or plate fixation.
abstract: BACKGROUND
  Most patients with a displaced midshaft clavicular fracture can be treated either operatively or nonoperatively, with similar long-term outcomes. The treatment choice depends on individual preferences, and is therefore suited for a shared decision making (SDM) approach. However, little is known about SDM in fracture treatment. The purpose of this study was to evaluate the current daily practice of shared decisional behaviour in clavicular fracture treatment, in order to assess the need for improvement and set a baseline level for future research.
  
  
  METHODS
  All consecutive adult patients treated in two hospitals for a displaced, midshaft clavicular fracture in 2015 filled out a questionnaire shortly after the decision making moment, that consisted of questions concerning their knowledge and preferences regarding the treatment options; the SDM-Q-9-NL to measure the perceived degree of SDM, and the Control Preferences Scale to measure patients' preferred and actual roles in decision making.
  
  
  RESULTS
  Fifty patients were included. Eighteen percent of the patients were unaware of the treatment options before the consultation, 48% had no preference for either treatment option. The mean score for perceived degree of SDM was 74 out of 100 (SD 23, range 12.5-100). In 68% of patients, the preferred role matched the actual role in making the decision. Sixteen patients (32%) would have preferred either a less (n=8) or a more (n=8) active role.
  
  
  CONCLUSIONS
  The patient-reported level of SDM in treatment decisions for clavicular fractures was high, but not all patients had the role in this process that they preferred. To improve patients' involvement in the treatment decision making process for clavicular fractures, it is important to create general awareness about SDM, and increase knowledge of orthopaedic trauma surgeons about SDM behaviour.
authors.affiliation: Department of Trauma Surgery, Leiden University Medical Center, Leiden, The Netherlands. Electronic address: s.woltz@lumc.nl.
authors.forename: Sarah
authors.initials: S
authors.lastname: Woltz
authors.affiliation: Department of Trauma Surgery, Leiden University Medical Center, Leiden, The Netherlands.
authors.forename: Pieta
authors.initials: P
authors.lastname: Krijnen
authors.affiliation: Haaglanden Medical Center, Department of Trauma Surgery, The Netherlands.
authors.forename: Sven A G
authors.initials: SAG
authors.lastname: Meylaerts
authors.affiliation: Department of Medical Decision Making/Quality of Care Institute, Leiden University Medical Center, Leiden, The Netherlands.
authors.forename: Arwen H
authors.initials: AH
authors.lastname: Pieterse
authors.affiliation: Department of Trauma Surgery, Leiden University Medical Center, Leiden, The Netherlands.
authors.forename: Inger B
authors.initials: IB
authors.lastname: Schipper
mesh_terms: D000328:Adult; D000368:Aged; D001860:Bone Plates; D002755:Choice Behavior; D002968:Clavicle / Q000293:injuries*; D003430:Cross-Sectional Studies; D003657:Decision Making; D005260:Female; D005592:Fracture Fixation / Q000379:methods / Q000523:psychology; D017102:Fracture Healing; D050723:Fractures, Bone / Q000523:psychology / Q000628:therapy*; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D008297:Male; D008875:Middle Aged; D009426:Netherlands; D010358:Patient Participation; D010817:Physician-Patient Relations; D012017:Referral and Consultation; D018570:Risk Assessment; D016896:Treatment Outcome; D055815:Young Adult
keywords: Clavicular fracture; Patient-centred medicine; Shared decision making