What Your Patient Wants Is Not What They Think They Get: New Study

A new study comparing how surgeons think they are doing versus how the patient thinks they are doing, uncovered a surprising gap—and not to the surgeon’s favor. This new study (n=136) found that surgeons may have a more optimistic view of their patient’s involvement in decision making than the patient does. Indeed, that gap may be around 20%.

The study, which was conducted at The University of Texas at Austin, “Patient and Surgeon Ratings of Patient Involvement in Decision-Making Are Not Aligned,” appears in the May 4, 2022, edition of The Journal of Bone and Joint Surgery.

Patient’s Perceptions vs Their Experienced Reality

The researchers looked at 136 patients who were admitted for upper- or lower-extremity musculoskeletal care from one facility from July 2019 to November 2020. Prior to the visit, patients were asked about their preferred level of involvement and completed a questionnaire that asked about various demographics and psychological factors. Post-visit, the patients and their surgeons were asked to rate their own perception of the patient’s involvement in decision-making.

OTW talked to co-author and orthopedic surgeon, David Ring, M.D., Ph.D., the associate dean for comprehensive care and professor of surgery and psychiatry at University of Texas Dell Medical School. He explained the purpose of the study and highlighted its first author: “Aaron, the first author and a medical student aiming for orthopedic residency, has done a lot of research on decision-making. Given that many surgeons have limited interest in decision aids and other tools for enhancing patient involvement in decisions, I think he was interested in determining if surgeons sense that they were involving patients in decisions was accurate.”

In addition to age, sex, race/ethnicity, household income and education statistics, the team also gathered measures of psychological factors (using the Patient Health Questionnaire-2 and the Pain Self-Efficacy Questionnaire-2) and patient-preferred involvement in decision-making. A higher score on the Control Preferences Scale reflected a greater preference for involvement in decision-making.

How Big Is the Patient vs Surgeon Gap?

The researchers found poor agreement between patients and surgeons as to the extent of patient participation in decision-making. The median difference on a 5-point Likert scale was 1 point (interquartile range: 0 to 1). Specialist-perceived patient involvement in decision-making was not related to patient-perceived involvement. The was a sole factor associated with higher patient-rated involvement: higher patient-preferred involvement.

Surgeons rated patients lacking a high school diploma as being less involved in decision-making. The authors suggest that novel communication and decision-making strategies can help patients more fully understand what matters most to them. They also highlight the need for clinician checklists (to identify and reorient common misinterpretations of symptoms), and decision aids/motivational interviewing to help align patient choices with their values.

The authors wrote, “Considering that this was observed in a care unit specifically conceptualized with the patient at the center of care, we interpret this finding as evidence that partnering with patients on their health is not straightforward and that learning how to do it well will benefit from focused strategy, measurement, and sequential improvement.”

“This was a simple study showing that patients didn’t feel as involved in decisions as the surgeons thought they were,” explained Dr. Ring. “I hope it will encourage humility and curiosity. I’m certain that every surgeon believes that patients have the key role in decisions. This evidence confirming that it’s not as easy to involve patients in decisions as one might think can create an openness to new communication and care strategies.”