title: Understanding Preferences for Treatment After Hypothetical First-Time Anterior Shoulder Dislocation: Surveying an Online Panel Utilizing a Novel Shared Decision-Making Tool.
abstract: BACKGROUND
  Although surgical management of a first-time anterior shoulder dislocation (FTASD) can reduce the risk of recurrent dislocation, other treatment characteristics, costs, and outcomes are important to patients considering treatment options. While patient preferences, such as those elicited by conjoint analysis, have been shown to be important in medical decision-making, the magnitudes or effects of patient preferences in treating an FTASD are unknown.
  
  
  OBJECTIVE
  To test a novel shared decision-making tool after sustained FTASD. Specifically measured were the following: (1) importance of aspects of operative versus nonoperative treatment, (2) respondents' agreement with results generated by the tool, (3) willingness to share these results with physicians, and (4) association of results with choice of treatment after FTASD.
  
  
  METHODS
  Cross-sectional study; Level of evidence, 3.
  
  
  METHODS
  A tool was designed and tested using members of Amazon Mechanical Turk, an online panel. The tool included an adaptive conjoint analysis exercise, a method to understand individuals' perceived importance of the following attributes of treatment: (1) chance of recurrent dislocation, (2) cost, (3) short-term limits on shoulder motion, (4) limits on participation in high-risk activities, and (5) duration of physical therapy. Respondents then chose between operative and nonoperative treatment for hypothetical shoulder dislocation.
  
  
  RESULTS
  Overall, 374 of 501 (75%) respondents met the inclusion criteria, of which most were young, active males; one-third reported prior dislocation. From the conjoint analysis, the importance of recurrent dislocation and cost of treatment were the most important attributes. A substantial majority agreed with the tool's ability to generate representative preferences and indicated that they would share these preferences with their physician. Importance of recurrence proved significantly predictive of respondents' treatment choices, independent of sex or age; however, activity level was important to previous dislocators. A total of 125 (55%) males and 33 (23%) females chose surgery after FTASD, as did 37% of previous dislocators compared with 45% of nondislocators.
  
  
  CONCLUSIONS
  When given thorough information about the risks and benefits, respondents had strong preferences for operative treatment after an FTASD. Respondents agreed with the survey results and wanted to share the information with providers. Recurrence was the most important attribute and played a role in decisions about treatment.
authors.affiliation: Department of Orthopaedic Surgery, University of South Florida, Tampa, Florida, USA.
authors.forename: Ben
authors.initials: B
authors.lastname: Streufert
authors.affiliation: Duke Clinical Research Institute, Duke University, Durham, North Carolina, USA.
authors.forename: Shelby D
authors.initials: SD
authors.lastname: Reed
authors.affiliation: Center for Applied Genomics and Precision Medicine, Duke University, Durham, North Carolina, USA.; Department of Medicine, Duke University, Durham, North Carolina, USA.
authors.forename: Lori A
authors.initials: LA
authors.lastname: Orlando
authors.affiliation: Duke Sports Science Institute, Department of Orthopaedic Surgery, Duke University, Durham, North Carolina, USA.
authors.forename: Dean C
authors.initials: DC
authors.lastname: Taylor
authors.affiliation: The Fuqua School of Business, Duke University, Durham, North Carolina, USA.
authors.forename: Joel C
authors.initials: JC
authors.lastname: Huber
authors.affiliation: Duke Orthopaedic Surgery, Durham, North Carolina, USA.
authors.forename: Richard C
authors.initials: RC
authors.lastname: Mather
keywords: economic and decision analysis; instability; shoulder