Weak Link Between Patient Perception and Reality

Researchers from Stanford University set out to determine if patient-perceived involvement correlates with observed measurements of patient involvement in decision-making in orthopedic surgery. They also wanted to see if patient demographics are associated with perceived and observed measurements of patient involvement in decision-making.

Their work, “Patient Perceptions Correlate Weakly with Observed Patient Involvement in Decision-making in Orthopaedic Surgery,” appears in the September 2018 edition of Clinical Orthopaedics and Related Research.

The authors wrote, “We performed a prospective, observational study to compare observed and perceived patient involvement in new patient consultations for eight orthopaedic surgeons in subspecialties including hand/upper extremity, total joint arthroplasty, spine, sports, trauma, foot and ankle, and tumor.

We enrolled 117 English-literate patients 18 years or older over an enrollment period of 2 months. A member of the research team assessed observed patient involvement during a consultation with the Observing Patient Involvement in Decision-Making (OPTION) instrument (scaled 1-100 with higher scores representing greater involvement).”

Robin Kamal, M.D. is assistant professor of Orthopaedic Surgery at the Stanford University Medical Center. A co-author on the study, Dr. Kamal told OTW, “After the consultation, we asked patients to complete a questionnaire with demographic information including age, sex, race, education, income, marital status, employment status, and injury type. Patients also completed the Perceived Involvement in Care Scale (PICS), which measures patient-perceived involvement (scaled 1-13 with higher scores representing greater involvement). Both instruments are validated in multiple studies in various specialties and the physicians were blinded to the instruments used. We assessed the correlation between observed and patient-perceived involvement as well as tested the association between patient demographics and patient involvement scores.”

“There is movement towards collaborative decision making (shared decision making) when making treatment decisions with patients. This process improves care based on patients’ values and preferences. There is not a well-established method to measure when shared decision making has occurred.”

“We found that there is a disconnect in how much a patient perceives he is involved versus how involved he actually is when the interaction is observed. This study brings up the question of which method is the best way to measure shared decision making.”