Informed, Patient-Centered Decisions Associated with Better Health Outcomes in Orthopedics: Prospective Cohort Study

Med Decis Making. 2018 Nov;38(8):1018-1026. doi: 10.1177/0272989X18801308.


Background: A goal of shared decision making (SDM) is to ensure patients are well informed and receive preferred treatments. However, the relationship between SDM and health outcomes is not clear.

Objective: The purpose was to examine whether patients who are well informed and receive their preferred treatment have better health outcomes.

Design, setting, and participants: A prospective cohort study at an academic medical center surveyed new patients with knee or hip osteoarthritis, herniated disc, or spinal stenosis 1 week after seeing a specialist and again 6 months later. Main Outcomes and Measures. The survey assessed knowledge, preferred treatment, and quality of life (QoL). The percentage of patients who were well informed and received preferred treatment was calculated (informed, patient centered [IPC]). A follow-up survey assessed QoL, decision regret, and satisfaction. Regression analyses with generalized estimating equations to account for clustering tested a priori hypotheses that patients who made IPC decisions would have higher QoL.

Results: Response rate was 70.3% (652/926) for initial and 85% (551/648) for follow-up. The sample was 63.9 years old, 52.8% were female, 62.6% were college educated, and 49% had surgery. One-third (37.4%) made IPC decisions. Participants who made IPC decisions had significantly better overall (0.05 points (SE 0.02) for EQ-5D, P = 0.004) and disease-specific quality of life (4.22 points [SE 1.82] for knee, P = 0.02; 4.46 points [SE 1.54] for hip, P = 0.004; and 6.01 points [SE 1.51] for back, P < 0.0001), higher satisfaction and less regret.

Limitations: Observational study at a single academic center with limited diversity.

Conclusions: Well-informed patients who receive their preferred treatment also had better health outcomes and higher satisfaction.

Keywords: low back pain; osteoarthritis; patient reported outcomes; shared decision making; surgery.

Publication types

  • Observational Study
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Academic Medical Centers
  • Aged
  • Decision Making*
  • Decision Support Techniques
  • Female
  • Health Knowledge, Attitudes, Practice*
  • Humans
  • Male
  • Middle Aged
  • Orthopedics / organization & administration*
  • Orthopedics / standards
  • Osteoarthritis / surgery
  • Outcome Assessment, Health Care
  • Patient Participation / methods*
  • Patient Preference
  • Patient Satisfaction
  • Patient-Centered Care / methods*
  • Prospective Studies
  • Quality of Life
  • Socioeconomic Factors
  • Spinal Diseases / surgery