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Paramsewaran P, Fresco R, Brody M, Brogan DM, Calfee RP, Dy CJ. Factors Influencing Patient Experience After Cubital Tunnel Syndrome Surgery. J Hand Surg Am 2023:S0363-5023(23)00143-0. [PMID: 37149802 DOI: 10.1016/j.jhsa.2023.03.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2022] [Revised: 03/04/2023] [Accepted: 03/17/2023] [Indexed: 05/08/2023]
Abstract
PURPOSE The purpose of this study was to use qualitative methodology to better understand patient experiences after cubital tunnel surgery, with the goal of identifying areas of improvement in delivery of care. METHODS Patients who underwent surgery (in situ decompression or anterior transposition) for cubital tunnel syndrome within the last 12 months, which was performed by one of three fellowship-trained hand surgeons, were identified. Participants were invited to an interview regarding "their experiences with ulnar nerve surgery." An interview guide with semistructured, open-ended questions regarding the decision for surgery, treatment goals, and the recovery process was used. Interim data analyses were conducted to assess emerging themes, and interviews were continued until thematic saturation was achieved. RESULTS Seventeen participants completed interviews; the mean age of study participants was 57 years, and 71% were women. The mean time between surgery and the interview was 6 months. Participants identified the following two key areas that could improve their surgical experience: (1) the need for detailed preoperative education about the surgery and recovery process, (2) and the importance of discussing treatment goals and expectations. Participants suggested providing both written and online resources to patients, including specific details about incision size and recovery process in education materials, and setting expectations for symptom resolution. CONCLUSIONS Although the overall patient experience after cubital tunnel surgery was positive, participants noted that there is a need for providing improved educational resources and counseling before surgery. CLINICAL RELEVANCE Addressing education and counseling needs before cubital tunnel surgery will help surgeons to improve delivery of care.
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Affiliation(s)
- Priyanka Paramsewaran
- Department of Orthopaedic Surgery, Washington University School of Medicine in St Louis, St Louis, MO
| | - Rabiah Fresco
- Department of Orthopaedic Surgery, Washington University School of Medicine in St Louis, St Louis, MO
| | - Madison Brody
- Department of Orthopaedic Surgery, Washington University School of Medicine in St Louis, St Louis, MO
| | - David M Brogan
- Department of Orthopaedic Surgery, Washington University School of Medicine in St Louis, St Louis, MO
| | - Ryan P Calfee
- Department of Orthopaedic Surgery, Washington University School of Medicine in St Louis, St Louis, MO
| | - Christopher J Dy
- Department of Orthopaedic Surgery, Washington University School of Medicine in St Louis, St Louis, MO.
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Ngoue M, Lam R, Pierson SR, Smoot JB, Ring D, Crijns T. Does Addressing Mental Health During a Musculoskeletal Specialty Care Visit Affect Patient-rated Clinician Empathy? Clin Orthop Relat Res 2023; 481:976-983. [PMID: 36729889 PMCID: PMC10097555 DOI: 10.1097/corr.0000000000002494] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2022] [Accepted: 10/25/2022] [Indexed: 02/03/2023]
Abstract
BACKGROUND Unhelpful thoughts and feelings of worry or despair about symptoms account for a notable amount of the variation in musculoskeletal symptom intensity. Specialists may be best positioned to diagnose these treatable aspects of musculoskeletal illness. Musculoskeletal specialists might be concerned that addressing mental health could offend the patient, and avoidance might delay mental health diagnosis and treatment. Evidence that conversations about mental health are not associated with diminished patient experience might increase specialist confidence in the timely diagnosis and initial motivation to treat unhelpful thoughts and feelings of worry or despair. QUESTIONS/PURPOSES Using transcripts of videotaped and audiotaped specialty care visits in which at least one instance of patient language indicating an unhelpful thought about symptoms or feelings of worry or despair surfaced, we asked: (1) Is clinician discussion of mental health associated with lower patient-rated clinician empathy, accounting for other factors? (2) Are clinician discussions of mental health associated with patient demographics, patient mental health measures, or specific clinicians? METHODS Using a database of transcripts of 212 patients that were audio or video recorded for prior studies, we identified 144 transcripts in which language reflecting either an unhelpful thought or feelings of distress (worry or despair) about symptoms was detected. These were labeled mental health opportunities. Patients were invited on days when the researcher making video or audio records was available, and people were invited based on the researcher's availability, the patient's cognitive ability, and whether the patient spoke English. Exclusions were not tracked in those original studies, but few patients declined. There were 80 women and 64 men, with a mean age of 45 ± 15 years. Participants completed measures of health anxiety, catastrophic thinking, symptoms of depression, and perceived clinician empathy. Factors associated with perceived clinician empathy and clinician discussion of mental health were sought in bivariate and multivariable analyses. RESULTS Greater patient-rated clinician empathy was not associated with clinician initiation of a mental health discussion (regression coefficient 0.98 [95% confidence interval 0.89 to 1.1]; p = 0.65). A clinician-initiated mental health discussion was not associated with any factors. CONCLUSION The observation that a clinician-initiated mental health discussion was not associated with diminished patient ratings of clinician empathy and was independent from other factors indicates that generally, discussion of mental health does not harm patient-clinician relationship. Musculoskeletal clinicians could be the first to notice disproportionate symptoms or misconceptions and distress about symptoms, and based on the evidence from this study, they can be confident about initiating a discussion about these mental health priorities to avoid delays in diagnosis and treatment. Future studies can address the impact of training clinicians to notice unhelpful thoughts and signs of distress and discuss them with compassion in a specialty care visit; other studies might evaluate the impact of timely diagnosis of opportunities for improvement in mental health on comfort, capability, and optimal stewardship of resources.
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Affiliation(s)
- Marielle Ngoue
- Department of Surgery and Perioperative Care, Dell Medical School, University of Texas at Austin. Austin, TX, USA
| | - Ryan Lam
- University of Texas at Austin. Austin, TX, USA
| | - S. Ryan Pierson
- Department of Surgery and Perioperative Care, Dell Medical School, University of Texas at Austin. Austin, TX, USA
| | - J. Brannan Smoot
- Department of Surgery and Perioperative Care, Dell Medical School, University of Texas at Austin. Austin, TX, USA
| | - David Ring
- Department of Surgery and Perioperative Care, Dell Medical School, University of Texas at Austin. Austin, TX, USA
| | - Tom Crijns
- Department of Surgery and Perioperative Care, Dell Medical School, University of Texas at Austin. Austin, TX, USA
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Veenendaal HV, Chernova G, Bouman CM, Etten-Jamaludin FSV, Dieren SV, Ubbink DT. Shared decision-making and the duration of medical consultations: A systematic review and meta-analysis. PATIENT EDUCATION AND COUNSELING 2023; 107:107561. [PMID: 36434862 DOI: 10.1016/j.pec.2022.11.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/04/2022] [Revised: 10/07/2022] [Accepted: 11/03/2022] [Indexed: 06/16/2023]
Abstract
OBJECTIVE 1) determine whether increased levels of Shared Decision-Making (SDM) affect consultation duration, 2) investigate the intervention characteristics involved. METHODS MEDLINE, EMBASE, CINAHL and Cochrane library were systematically searched for experimental and cross-sectional studies up to December 2021. A best-evidence synthesis was performed, and interventions characteristics that increased at least one SDM-outcome, were pooled and descriptively analyzed. RESULTS Sixty-three studies were selected: 28 randomized clinical trials, 8 quasi-experimental studies, and 27 cross-sectional studies. Overall, pooling of data was not possible due to substantial heterogeneity. No differences in consultation duration were found more often than increased or decreased durations. . Consultation times (minutes:seconds) were significantly increased only among interventions that: 1) targeted clinicians only (Mean Difference [MD] 1:30, 95% Confidence Interval [CI] 0:24-2:37); 2) were performed in primary care (MD 2:05, 95%CI 0:11-3:59; 3) used a group format (MD 2:25, 95%CI 0:45-4:05); 4) were not theory-based (MD 4:01, 95%CI 0:38-7:23). CONCLUSION Applying SDM does not necessarily require longer consultation durations. Theory-based, multilevel implementation approaches possibly lower the risk of increasing consultation durations. PRACTICE IMPLICATIONS The commonly heard concern that time hinders SDM implementation can be contradicted, but implementation demands multifaceted approaches and space for training and adapting work processes.
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Affiliation(s)
- Haske van Veenendaal
- Erasmus School of Health Policy & Management, Erasmus University Rotterdam, P.O. Box 1738, 3000 DR Rotterdam, the Netherlands.
| | - Genya Chernova
- Amsterdam UMC, location University of Amsterdam, Surgery, Meibergdreef 9, 1105 AZ Amsterdam, the Netherlands.
| | - Carlijn Mb Bouman
- Amsterdam UMC, location University of Amsterdam, Surgery, Meibergdreef 9, 1105 AZ Amsterdam, the Netherlands.
| | - Faridi S van Etten-Jamaludin
- Amsterdam UMC, location University of Amsterdam, Medical Library AMC, Meibergdreef 9, 1105AZ Amsterdam, the Netherlands.
| | - Susan van Dieren
- Amsterdam UMC, location University of Amsterdam, Surgery, Meibergdreef 9, 1105 AZ Amsterdam, the Netherlands.
| | - Dirk T Ubbink
- Amsterdam UMC, location University of Amsterdam, Surgery, Meibergdreef 9, 1105 AZ Amsterdam, the Netherlands.
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Simmons CS, Roche C, Schoch BS, Parsons M, Aibinder WR. Surgeon confidence in planning total shoulder arthroplasty improves after consulting a clinical decision support tool. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY & TRAUMATOLOGY : ORTHOPEDIE TRAUMATOLOGIE 2022:10.1007/s00590-022-03446-1. [PMID: 36436090 DOI: 10.1007/s00590-022-03446-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/25/2022] [Accepted: 11/20/2022] [Indexed: 06/16/2023]
Abstract
PURPOSE Software algorithms are increasingly available as clinical decision support tools (CDSTs) to support shared decision-making. We sought to understand if patient-specific predictions from a CDST would impact orthopedic surgeons' preoperative planning decisions and corresponding confidence. METHODS We performed a survey study of orthopedic surgeons with at minimum of 2 years of independent shoulder arthroplasty experience. We generated patient profiles for 18 faux cases presenting with glenohumeral osteoarthritis and emailed 93 surgeons requesting their recommendation for anatomic or reverse total shoulder arthroplasty for each case and their certainty in their recommendation on a 4-point Likert scale. The thirty respondents were later sent a second survey with the same cases that now included predicted patient-specific outcomes and complication rates generated by a CDST. RESULTS Initial recommendations and changes in recommendation varied widely by surgeon and by case. After viewing the results of the CDST, surgeons switched from anatomic to reverse recommendations in 46 instances (12% of initial anatomic) and from reverse to anatomic in 22 instances (6% of initial reverse). Overall, surgeon change in confidence increased significantly across all responses (p = 0.0001), with certain cases and certain surgeons having significant changes. Change in confidence did not correlate with surgeon-specific factors, including years in practice. CONCLUSION The addition of CDST reports to preoperative planning for anatomic and reverse total shoulder arthroplasty informed decision-making but did not direct recommendations uniformly. However, the CDST information provided did increase surgeon confidence regardless of implant selection and irrespective of surgeon experience.
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Affiliation(s)
| | | | - Bradley S Schoch
- Department of Orthopedic Surgery, Mayo Clinic, Jacksonville, FL, USA
| | - Moby Parsons
- The Knee Hip and Shoulder Center, Portsmouth, NH, USA
| | - William R Aibinder
- Department of Orthopaedic Surgery, University of Michigan, Ann Arbor, MI, USA.
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Alokozai A, Lin E, Crijns TJ, Ring D, Bozic K, Koenig K, Jayakumar P. Patient and Surgeon Ratings of Patient Involvement in Decision-Making Are Not Aligned. J Bone Joint Surg Am 2022; 104:767-773. [PMID: 35142709 DOI: 10.2106/jbjs.21.00709] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Specialists want to guide patients toward making informed treatment choices consistent with what matters most to them (their values). One measure of this goal is alignment between patient and surgeon-perceived involvement in decision-making. We performed a cross-sectional survey of patients presenting for musculoskeletal specialty care to determine agreement between patients and surgeons regarding patient involvement in shared decision-making. We also tested (1) factors associated with specialist-perceived involvement, accounting for the patient's perceived involvement in decision-making, and (2) factors associated with patient perception of involvement in decision-making, accounting for ratings of preferred involvement. METHODS In this cross-sectional survey, 136 patients seeking musculoskeletal care for conditions involving the upper or lower extremities rated their preferred level of involvement in decision-making (Control Preferences Scale) before the visit and their perceived level of involvement (Modified Control Preferences Scale) after the visit. Participants also completed measures of symptoms of depression and pain self-efficacy. After the visit, the surgeons rated their perception of the patient's involvement in decision-making (Modified Control Preferences Scale). RESULTS There was poor agreement between patients and surgeons regarding the extent of patient participation in decision-making (ICC = 0.11). The median difference was 1 point on a 5-point Likert scale (interquartile range: 0 to 1). Accounting for demographic characteristics and personal factors in multivariable analysis, specialists rated patients who did not have a high school diploma as having less involvement in decision-making. Specialist-perceived patient involvement in decision-making was not related to patient-perceived involvement. The only factor associated with higher patient-rated involvement was higher patient-preferred involvement (OR = 3.9; 95% CI = 2.6 to 5.8; p < 0.001). CONCLUSIONS The observation that surgeons misperceive patient participation in decision-making emphasizes the need for strategies to ensure patient participation, such as methods to help patients gain awareness of what matters most to them (their values), clinician checklists for identification and reorientation of common misinterpretations of symptoms, and decision aids or motivational interviewing tools that can help to ensure that patient choices are consistent with their values and are unhindered by misconceptions.
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Affiliation(s)
- Aaron Alokozai
- Tulane University School of Medicine, New Orleans, Louisiana
| | - Eugenia Lin
- Department of Surgery and Perioperative Care, Dell Medical School, The University of Texas at Austin, Austin, Texas
| | - Tom J Crijns
- Department of Surgery and Perioperative Care, Dell Medical School, The University of Texas at Austin, Austin, Texas
| | - David Ring
- Department of Surgery and Perioperative Care, Dell Medical School, The University of Texas at Austin, Austin, Texas
| | - Kevin Bozic
- Department of Surgery and Perioperative Care, Dell Medical School, The University of Texas at Austin, Austin, Texas
| | - Karl Koenig
- Department of Surgery and Perioperative Care, Dell Medical School, The University of Texas at Austin, Austin, Texas
| | - Prakash Jayakumar
- Department of Surgery and Perioperative Care, Dell Medical School, The University of Texas at Austin, Austin, Texas
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van Rossenberg LX, Ring D, Jacobs X, Sulkers G, van Heijl M, van Hoorn BT. Patient Perceived Involvement in Their Treatment is Influenced by Factors Other Than Independently Rated Clinician Communication Effectiveness. J Patient Exp 2021; 8:23743735211065261. [PMID: 34901411 PMCID: PMC8664301 DOI: 10.1177/23743735211065261] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
We analyzed (1) the correspondence of patient and clinician perceived patient involvement in decision making and ratings made by independent observer's independent ratings, as well as (2), factors associated with patient-perceived involvement, among patients seeking hand specialty care. During 63 visits, the patient, their hand specialist, and 2 independent observers each rated patient involvement in decision making using the 9-item shared decision-making questionnaire for patients and clinicians, and the 5-item observing patient involvement scale (OPTION-5). We also measured health literacy (Newest Vital Sign), patient and visit characteristics (gender, age, race, years of education, occupation, marital status, and family present). There was no correlation (ρ = 0.17; P = .17) between patient (median 42, IQR 36-44.5) and clinician (38, IQR 35-43) ratings of patient involvement in decision making. Independently rated patient involvement correlated moderately with a specialist (ρ = 0.35, P <.01), but not patient (ρ = 0.22, P = .08) ratings. The finding that patient perception of their involvement in decision making has little or no relationship to independently rated clinician communication effectiveness and effort, suggests that other aspects of the encounter-such as empathy and trust-may merit investigation as mediators of the patient agency.
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Affiliation(s)
- Luke X van Rossenberg
- Department of Surgery, Hand Service, Utrecht Medical Center, Medical University of Utrecht, Utrecht, the Netherlands
| | - David Ring
- Department of Surgery and Perioperative Care, Dell Medical School at the University of Texas at Austin, Austin, Texas, USA
| | - Xander Jacobs
- Department of Plastic Surgery, Hand Service, Diakonessenhuis Utrecht, Utrecht, the Netherlands
| | - George Sulkers
- Department of Plastic Surgery, Hand Service, Diakonessenhuis Utrecht, Utrecht, the Netherlands
| | - Mark van Heijl
- Department of Surgery, Hand Service, Utrecht Medical Center, Medical University of Utrecht, Utrecht, the Netherlands
| | - Bastiaan T van Hoorn
- Department of Surgery, Hand Service, Utrecht Medical Center, Medical University of Utrecht, Utrecht, the Netherlands
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