Shared Decision Making Improves Outcomes, Patient Experience

    Well-informed patients who decide with their orthopaedic surgeon what treatment is best for them have better outcomes and higher patient satisfaction rates, according to new study presented at the 2017 Annual Meeting of the American Academy of Orthopaedic Surgeons.

    Shared decision making (SDM), a key component of patient-centered health care, is a process in which physicians and patients work together to make decisions and select tests, treatments, and care plans based on clinical evidence that balances risks and expected outcomes with patient preferences and values.

    Researchers surveyed more than 550 patients with hip or knee osteoarthritis, a herniated disc, or lumbar spinal stenosis. In an initial survey, they assessed patients’ knowledge of their condition, preferred treatment (surgical or non-surgical), baseline quality of life, physical movement capabilities, and level of pain.

    A follow-up survey was administered 6 months after the initial office visit to patients who had non-surgical treatment or 6 months after surgery for those who had surgery. The follow-up questionnaires focused on treatment, quality of life, regret over their treatment choice, and treatment outcomes.

    Patients with a good understanding of their condition who received their preferred treatment were considered to have made informed patient-centered (IPC) decisions.

    The average age of the patients in the study was 63.9 years. More than half (53%) of patients were female, 92% were white and 63% had a college degree. About half of the patients underwent surgery within 6 months of the initial office visit.

    One-third of the patients were deemed “IPC,” and at the follow-up assessment these patients had higher scores related to overall and disease-specific quality of life outcomes. These patients also were more likely to be extremely satisfied with their pain management plan (76.7% vs 41.9%), very or extremely satisfied with their treatment (70.7% vs 34.7%), and had less regret with their treatment decision (5.2% vs 15%).

    “This study is unique in its evaluation of the implementation of a shared decision making process as part of a real world orthopaedic elective surgical practice,” said co-study author Thomas Cha, MD, MBA, assistant chief of surgery at the Orthopaedic Spine Center at Massachusetts General Hospital, and an instructor at Harvard Medical School.

    “Shared decision making did not just result in better patient experience ratings, but also improved patient outcomes.”

    Harry Rubash, MD, a co-author of the study and emeritus chief of the Department of Orthopaedic Surgery at Massachusetts General Hospital and the Edith M. Ashley professor of orthopaedic surgery at Harvard Medical School, said, “We are committed to improving outcomes after surgical procedures.

    “This study found that surgical patients who are more informed and have a clear preference for surgery have better outcomes. It highlights the need to focus further on decision making prior to elective surgeries and other treatments.”

    Funding for the study was provided, in part, by a grant from the Gordon and Betty Moore Foundation.


    Sepucha K, Freiberg AA, Mangla M, Malchau H, Rubas HE, Cha TD. Shared decision making in orthopaedic care leads to better health outcomes: a prospective cohort study. Presented at the 2017 Annual Meeting of the American Academy of Orthopaedic Surgeons, March 14-18, 2017, in San Diego, California.