People seeking care are at least a little unsettled by their symptoms. That’s part of what is motivating them to make the effort to seek care. Humans are programmed to mentally prepare to some degree for the worst case. This is one of our methods for adapting to the risks in the world. In this setting, clinician expertise that is intended to reassure or reorient may seem dismissive of patient concerns. Effective communication strategies are important. 

When people choose a test or treatment option, it’s important that the decision is not clouded by despair or misunderstanding. Gut feelings and worst-case thoughts are often inaccurate. Tools such as decision aids are designed to reduce decision conflict and help patients make decisions based on what matters most to them (their values) rather than misconceptions.

In several studies, we compared sources of decision conflict between surgeons and patients. Patients with carpal tunnel syndrome had lower self-efficacy and greater decisional conflict than their surgeon (1). Decision aids might help narrow this gap in decisional conflict. There were similar findings for trigger finger, a condition where the patient-surgeon relationship seems more critical (2). With respect to trigger finger, patients wanted less invasive treatments, wanted more power in decision-making, and preferred printed over web-based material (3). The findings were similar for carpal tunnel syndrome, particularly the differing opinions on the risks and benefits of diagnostic and therapeutic procedures (4). 

In a study of quality ratings regarding shared decision-making during audiotaped hand surgery office visits, we found that greater health anxiety was associated with less effective interactions(5). In a randomized trial that studied the addition of a decision aid to standard care among patients with trapeziometacarpal arthrosis, we found that decision aids reduce decision conflict (6). Surgeons should consider the routine use of decision aids to reduce decision conflict, particularly for people with greater stress and less effective cognitive coping strategies. Decision aids can be studied for their potential to reduce surgeon-to-surgeon variation and dissatisfaction with care. 

We are studying the ability to limit decision conflict by:  

1. Patients being able to view the clinician’s notes during visits.
2. Learning about decision-making preferences during recovery scenarios.
3. Using a question prompt list prior to a visit or procedure.  

References

1. Hageman MG, Bossen JK, Neuhaus V, Mudgal CS, Ring D; Science of Variation Group. Assessment of Decisional Conflict about the Treatment of carpal tunnel syndrome, Comparing Patients and Physicians. Arch Bone Jt Surg. 2016 Apr;4(2):150-5. PubMed PMID: 27200394; PubMed Central PMCID: PMC4852042.
2. Hageman MG, Döring AC, Spit SA, Guitton TG, Ring D. Assessment of Decisional Conflict about the Treatment of Trigger Finger, Comparing Patients and Physicians. Arch Bone Jt Surg. 2016 Oct;4(4):353-358. PubMed PMID: 27847849; PubMed Central PMCID: PMC5100452.
3. Döring AC, Hageman MG, Mulder FJ, Guitton TG, Ring D; Science of Variation Group; Science of Variation Group. Trigger finger: assessment of surgeon and patient preferences and priorities for decision making. J Hand Surg Am. 2014 Nov;39(11):2208-13.e2. doi: 10.1016/j.jhsa.2014.08.010. Epub 2014 Oct 3. PubMed PMID: 25283491.
4. Hageman MG, Kinaci A, Ju K, Guitton TG, Mudgal CS, Ring D; Science of Variation Group. Carpal tunnel syndrome: assessment of surgeon and patient preferences and priorities for decision-making. J Hand Surg Am. 2014 Sep;39(9):1799-1804.e1. doi: 10.1016/j.jhsa.2014.05.035. Epub 2014 Aug 1. PubMed PMID: 25087865.
5.  Bot AG, Bossen JK, Herndon JH, Ruchelsman DE, Ring D, Vranceanu AM. Informed shared decision-making and patient satisfaction. Psychosomatics. 2014 Nov-Dec;55(6):586-94. doi: 10.1016/j.psym.2013.12.013. Epub 2014 Jan 3. PubMed PMID: 24836165.
6. Wilkens SC, Ring D, Teunis T, Lee SP, Chen NC. Decision Aid for Trapeziometacarpal Arthritis: A Randomized Controlled Trial. J Hand Surg Am. 2018 Jul 18. Pii: S0363-5023(17)32162-7. doi: 10.1016/j.jhsa.2018.06.004. [Epub ahead of print] PubMed PMID: 30031600.