Can Upstream Patient Education Improve Fracture Care in a Digital World? Use of a Decision Aid for the Treatment of Displaced Diaphyseal Clavicle Fractures
| Autor: | Cara Lai, Malcolm R. DeBaun, Michael J. Gardner, Robin N. Kamal, Julius A. Bishop, Geoffrey D. Abrams, Noelle L Van Rysselberghe |
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| Rok vydání: | 2021 |
| Předmět: |
Telemedicine
medicine.medical_specialty Decision Making MEDLINE Decisional conflict Article Decision Support Techniques Fractures Bone 03 medical and health sciences 0302 clinical medicine Patient Education as Topic Intervention (counseling) Decision aids Humans Medicine Orthopedics and Sports Medicine 030222 orthopedics business.industry 030208 emergency & critical care medicine General Medicine Evidence-based medicine Clavicle Orthopedic surgery Physical therapy Surgery Patient Participation business Patient education |
| Zdroj: | J Orthop Trauma |
| ISSN: | 0890-5339 |
| DOI: | 10.1097/bot.0000000000001916 |
| Popis: | BACKGROUND The increasing proportion of telemedicine and virtual care in orthopaedic surgery presents an opportunity for upstream delivery of patient facing tools, such as decision aids. Displaced diaphyseal clavicle fractures (DDCFs) are ideal for a targeted intervention because there is no superior treatment, and decisions are often dependent on patient's preference. A decision aid provided before consultation may educate a patient and minimize decisional conflict similarly to inperson consultation with an orthopaedic traumatologist. METHODS Patients with DDCF were enrolled into 2 groups. The usual care group participated in a discussion with a trauma fellowship-trained orthopaedic surgeon. Patients in the intervention group were administered a DDCF decision aid designed with the International Patient Decision Aid Standards. Primary comparisons were made based on a decisional conflict score. Secondary outcomes included treatment choice, pain score, QuickDASH, and opinion toward cosmetic appearance. RESULTS A total of 41 patients were enrolled. Decisional conflict scores were similar and low between the 2 groups: 11.8 (usual care) and 11.4 (decision aid). There were no differences in secondary outcomes between usual care and the decision aid. DISCUSSION Our decision aid for the management of DDCF produces a similarly low decisional conflict score to consultation with an orthopaedic trauma surgeon. This decision aid could be a useful resource for surgeons who infrequently treat this injury or whose practices are shifting toward telemedicine visits. Providing a decision aid before consultation may help incorporate patient's values and preferences into the decision-making process between surgery and nonoperative management. LEVEL OF EVIDENCE Therapeutic Level II. See Instructions for Authors for a complete description of levels of evidence. |
| Databáze: | OpenAIRE |
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