July 2010
Surgery's pros and cons: How do we help patients choose their best option?
Shedding more light on the risks and benefits of certain surgeries could boost patients' satisfaction and might change how often those procedures are done. That's the theory behind a Group Health Research Institute study on "shared-decision making," among the largest underway in the nation.
Led by Associate Investigator David Arterburn, MD, MPH, and launched in 2009, the two-year study focuses on 12 "preference-sensitive conditions." Such conditions, including knee and hip osteoarthritis, have two or more treatment options, but little evidence for one choice over another.
Group Health Orthopedics Chief Charles Jung, MD, a physician participating in the study, believes in helping patients weigh the pros and cons of potential treatments. Unlike an emergency appendectomy, for example, joint replacement rarely requires a quick decision. And with no proof that surgery is best for everyone with osteoarthritis, each patient's preferences and lifestyle should drive the decision—along with their understanding of the risks and benefits of each choice for their particular situation.
Some patients prefer living with limited joint pain to spending months recovering from a surgery, says Dr. Jung. Others embrace the rehabilitation process, in hopes of eventually becoming pain-free. Being informed can help patients cope with rehabilitation better, he contends.
To help guide patient–provider communication in shared decision making, the study encourages doctors to recommend using "decision aids." These can be brochures, DVDs, and Web tools that provide balanced, evidence-based information, along with real patients' stories of their experiences.
The Commonwealth Fund, the Foundation for Informed Medical Decision Making, and the Group Health Foundation are funding the study, with regularly updated decision aids donated by Health Dialog, a Boston company.
By April 2010, more than 4,000 Group Health patients had viewed the DVDs. In a preliminary survey of about 400 patients, 72 percent deemed the aids excellent or very good at helping them understand their treatment choices. And 69 percent rated the aids as very good or excellent at helping them prepare to talk with their care providers.
The research team continues collecting data on how shared decision making affects patient and provider satisfaction and surgery rates. Dr. Arterburn thinks the process might make some procedures rarer and others more common.
"We have a need—and obligation—to educate our patients to be good consumers of health care," Dr. Arterburn says.
Group Health is testing DVDs on 12 topics:
- Hip osteoarthritis
- Knee osteoarthritis
- Coronary artery disease
- Benign prostatic hyperplasia
- Prostate cancer
- Uterine fibroids
- Abnormal uterine bleeding
- Ductal carcinoma in situ (a type of early-stage breast cancer)
- Other early-stage breast cancers
- Breast reconstruction
- Spinal stenosis
- Herniated disc