Do we really allow patient decision-making in rotator cuff surgery? A prospective randomized study

• Main Authors: Carlos Torrens, Joan Miquel, Fernando Santana
• Format: Article
• Language: English
• Published: BMC 2019-04-01
• Series: Journal of Orthopaedic Surgery and Research
• Subjects: Patient participation; Shared decision-making; Outcomes; Rotator cuff; Rotator cuff-repair
• Online Access: http://link.springer.com/article/10.1186/s13018-019-1157-2

Abstract Background There is a growing patient interest in being involved in the decision-making process. However, little information is provided on how this information should be structured. Does it make a difference, in patient treatment decision-making, whether information is given based on the benefits or on the side effects in rotator cuff disorders? Methods It is a prospective randomized study that includes patients diagnosed with rotator cuff tears. Patients were randomly allocated to either group A (benefit-inform) or group B (side effect-inform) and were asked to answer the following questions based on their assigned group: Group A: Your doctor informs you that you have a rotator cuff tear and states that if he/she surgically repairs your cuff tear you will improve and that the cuff remains healed at the 2-year follow-up in 71% of the cases where surgery is done. Would you choose surgery? Yes or No Group B: Your doctor informs you that you have a rotator cuff tear and that if he/she surgically repairs your cuff tear you will improve and that the cuff is torn again at 2-year follow-up in 29% of the cases where surgery is done. Would you choose surgery? Yes or No Age, gender, the shoulder affected and the functional status assessed through the Constant score were also recorded. Results 80 patients were randomized (43 to group A and 37 to group B). The patients assigned to group A (benefit) accepted surgery significantly more frequently than those assigned to group B (complication) (P = 0.000). In group A, 36 of 43 (84%) accepted surgery, compared to 17 of 37 (46%) in group B. Conclusions The way that information on rotator cuff disorders is provided strongly influences patients’ treatment decisions. Trial registration ClinicalTrials.gov, NCT03205852. Registered 29 June 2017. Retrospectively registered.