Do Patient Preferences Influence Surgeon Recommendations for Treatment?

Abstract

Background: When the best treatment option is uncertain, a patient's preference based on personal values should be<br />the source of most variation in diagnostic and therapeutic interventions. Unexplained surgeon-to-surgeon variation in<br />treatment for hand and upper extremity conditions suggests that surgeon preferences have more influence than patient<br />preferences.<br />Methods: A total of 184 surgeons reviewed 18 fictional scenarios of upper extremity conditions for which operative<br />treatment is discretionary and preference sensitive, and recommended either operative or non-operative treatment.<br />To test the influence of six specific patient preferences the preference was randomly assigned to each scenario in an<br />affirmative or negative manner. Surgeon characteristics were collected for each participant.<br />Results: Of the six preferences studied, four influenced surgeon recommendations. Surgeons were more likely<br />to recommend non-operative treatment when patients; preferred the least expensive treatment (adjusted OR,<br />0.82; 95% CI, 0.71 – 0.94; P=0.005), preferred non-operative treatment (adjusted OR, 0.82; 95% CI, 0.72 – 0.95;<br />P=0.006), were not concerned about aesthetics (adjusted OR, 1.15; 95% CI, 1.0 – 1.3; P=0.046), and when patients<br />only preferred operative treatment if there is consensus among surgeons that operative treatment is a useful option<br />(adjusted OR, 0.78; 95% CI, 0.68 – 0.89; P<0.001).<br />Conclusion: Patient preferences were found to have a measurable influence on surgeon treatment recommendations<br />though not as much as we expected-and surgeons on average interpreted surgery as more aesthetic. This emphasizes<br />the importance of strategies to help patients reflect on their values and ensure their preferences are consistent with<br />those values (e.g. use of decision-aids).<br />Level of evidence: III