Effectiveness of shared decision-making intervention in patients with lumbar degenerative diseases: A randomized controlled trial

Chia-Hsien Chen; Yi-No Kang; Po-Yao Chiu; Yi-Jing Huang; Glyn Elwyn; Meng-Huang Wu; Jiunn-Horng Kang; Wen-Hsuan Hou; Ken N Kuo

doi:10.1016/j.pec.2021.03.002

Effectiveness of shared decision-making intervention in patients with lumbar degenerative diseases: A randomized controlled trial

Patient Educ Couns. 2021 Oct;104(10):2498-2504. doi: 10.1016/j.pec.2021.03.002. Epub 2021 Mar 10.

Authors

Chia-Hsien Chen¹, Yi-No Kang², Po-Yao Chiu³, Yi-Jing Huang⁴, Glyn Elwyn⁵, Meng-Huang Wu⁶, Jiunn-Horng Kang⁷, Wen-Hsuan Hou⁸, Ken N Kuo⁹

Affiliations

¹ Department of Orthopedics, Taipei Medical University-Shuang Ho Hospital, Ministry of Health and Welfare, New Taipei City, Taiwan; Department of Orthopedic Surgery, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan; Graduate Institute of Biomedical Materials and Tissue Engineering, College of Biomedical Engineering, Taipei Medical University, Taipei, Taiwan.
² Institute of Health Policy and Management, College of Public Health, National Taiwan University, Taipei, Taiwan; Evidence-Based Medicine Center, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan.
³ Master Program in Long-Term Care, College of Nursing, Taipei Medical University, Taipei, Taiwan.
⁴ Research Center of Rehabilitation Engineering and Assistive Technology, College of Medicine, Taipei Medical University, Taipei, Taiwan.
⁵ The Dartmouth Institute for Health Policy and Clinical Practice, Dartmouth College, Hanover, NH, USA; Scientific Institute for Quality of Healthcare, Radboud University Nijmegen Medical Centre, Amsterdam, Netherlands; Cochrane Institute for Primary Care and Public Health, Cardiff University, Cardiff, UK.
⁶ School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan; Department of Orthopedics, Taipei Medical University Hospital, Taipei, Taiwan.
⁷ Department of Physical Medicine and Rehabilitation, Taipei Medical University Hospital, Taipei, Taiwan; Department of Physical Medicine and Rehabilitation, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan.
⁸ Master Program in Long-Term Care, College of Nursing, Taipei Medical University, Taipei, Taiwan; Department of Physical Medicine and Rehabilitation, Taipei Medical University Hospital, Taipei, Taiwan; Center of Evidence-Based Medicine, Department of Education, Taipei Medical University Hospital, Taipei, Taiwan; Graduate Institute of Clinical Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan.
⁹ Cochrane Taiwan, Taipei Medical University, Taipei, Taiwan; Department of Orthopedic Surgery, National Taiwan University Hospital, Taipei, Taiwan.

PMID: 33741234
DOI: 10.1016/j.pec.2021.03.002

Abstract

Objective: To evaluate the efficacy of shared decision-making (SDM) intervention among patients with lumbar degenerative diseases (LDDs) in terms of decision self-efficacy, control preferences, SDM process, decision satisfaction, and conflict.

Methods: A total of 130 outpatients with LDDs recruited from orthopedic or rehabilitation clinics were randomly assigned to the SDM intervention (n = 67) or comparison (n = 63) groups. Patients in the intervention group received decision aids (DAs) with decision coaching and those in controlled group received standard educational materials from a health educator. The primary outcome was decision self-efficacy, and secondary outcomes were control preference, SDM process, conflict, and satisfaction.

Results: The SDM intervention significantly improved decision self-efficacy (mean difference [MD] = 7.1, 95% confidence interval [CI]: 1.7-12.5, partial η² = 0.05) and reduced conflict (MD = -7.0, 95% CI: -12.2 to -1.9, partial η² = 0.06), especially in patients without family involvement, compared with the health education group. However, no significant between-group differences were observed in other outcomes.

Conclusion: SDM intervention improved SDM self-efficacy and reduced conflict in patients with LDDs.

Practice implications: Clinicians can integrate DAs and decision coaching in SDM conversations. SDM intervention seems to engage patients in decision-making, especially those without family involvement.

Keywords: Lumbar degenerative diseases; Randomized controlled trial; Self-efficacy, decision aid; Shared decision-making.

Publication types

Randomized Controlled Trial
Research Support, Non-U.S. Gov't

MeSH terms

Ambulatory Care Facilities
Communication
Decision Making
Decision Making, Shared*
Humans
Mentoring*
Patient Participation