Current concepts of shared decision making in orthopedic surgery.
OBJECTIVE
The Shared Decision Making (SDM) model, a collaborative decision making process between the physician and patient to make an informed clinical decision that enhances the chance of treatment success as defined by each patient's preferences and values, has become a new and promising tool in the healthcare process; however, minimal data exists on its application in the orthopedic surgical specialty. Increasing evidence has demonstrated that this once novel idea can be implemented successfully in the orthopedic setting to improve patient outcomes.


RESULTS
SDM can be applied without significant increases in the office length. Patients report that a physician that takes the time to listen to them is among the most important factors in their care. When time was focused on the SDM process, there was a direct correlation between the time spent with a patient and patient satisfaction. Patients exposed to a decision aid prior to surgery gained a greater knowledge from baseline to make a higher quality decision that was consistent with their values. Involving family members preoperatively can help all patients adhere to postoperative regimens. Exposing patients to a decision aid can reduce expensive elective surgeries, in favor of non-operative management. Incorporating patient goals into the decision-making process has increased satisfaction, compliance, and outcomes. SDM is a two-way exchange of information that attempts to correct the inequality of power between the patient and physician. Decision-aids are helpful tools that facilitate the decision-making process. Treatment decisions are consistent with patient preferences and values when there may be no "best" therapy. A good patient-physician relationship is essential during the process to reduce decisional conflict and increase overall patient outcomes.
Philadelphia College of Osteopathic Medicine, Philadelphia, USA.
Kevin
K
Klifto
NYU Langone Medical Center Department of Orthopaedic Surgery, NYU Hospital for Joint Diseases, 301 East 17th Street; Suite 213, New York, NY, 10003, USA.
Christopher
C
Klifto
NYU Langone Medical Center Department of Orthopaedic Surgery, NYU Hospital for Joint Diseases, 301 East 17th Street; Suite 213, New York, NY, 10003, USA. James.Slover@nyumc.org.
James
J
Slover
Decision aids; Shared decision making; Total joint replacement