Scientific article
The Effect of Patient Involvement in Surgical Decision Making for Carpal Tunnel Release on Patient-Reported Outcome

https://doi.org/10.1016/j.jhsa.2013.12.025Get rights and content

Purpose

To investigate whether patient-reported outcomes are different according to patients' preference or experience in surgical decision making for carpal tunnel release.

Methods

We preoperatively surveyed 85 patients who underwent carpal tunnel release regarding their preferred role in the process of surgical decision making and assessed their experienced role in the actual decision making 6 months after surgery using a Control Preference Scale. For patient-reported surgical outcomes, we used the Disabilities of the Arm, Shoulder, and Hand questionnaire. We compared these outcomes with those of patients having different preferences or experiences in surgical decision making and also compared the outcomes according to whether the preferred roles match the experienced roles.

Results

The Disabilities of the Arm, Shoulder, and Hand scores were not significantly different between patients with different preferences for involvement in decision making for surgery or between those with different experiences in the actual decision making. However, those who experienced the same level of involvement as they had preferred were found to have better Disabilities of the Arm, Shoulder, and Hand scores than those who experienced a more active role or a more passive role than they had preferred.

Conclusions

This study demonstrates that patient-reported outcomes were not different between those with different preferences or experiences in surgical decision making for carpal tunnel release. However, this study suggests that patients whose experience in decision making matched with their preference may have better subjective outcomes after carpal tunnel release. This suggests that patients with carpal tunnel syndrome may benefit from physicians' efforts of identifying patients' preferences for involvement in decision making and matching the identified preferences to the decision-making process.

Type of study/level of evidence

Prognostic II.

Section snippets

Subjects

We obtained an approval for this study from our institutional review board. We prospectively recruited patients with CTS who underwent surgery by a single hand surgeon at our urban tertiary referral hospital between the period April 2010 and September 2011 and who were followed-up for more than 6 months. We excluded those with worker's compensation issues and those with associated conditions, such as cervical radiculopathy and cubital tunnel syndrome, or comorbidities such as diabetes mellitus,

Preferred and experienced roles in decision making

The patients expressed a wide range of preferred roles in decision making before surgery and also indicated diverse roles that they experienced during the actual decision-making process (Table 2).

Forty patients (47%) had the same level of involvement in decision making as they had preferred before surgery. Twenty-nine patients (34%) experienced a more active role than they had preferred before surgery, and 16 patients (19%) experienced a more passive role than they had preferred before surgery (

Discussion

In this study, we aimed to determine whether a particular preference or experience in surgical decision making was associated with patients' subjective outcomes for CTR. We found that patient-reported outcomes were not significantly different between patients with different preferences for involvement in decision making for surgery or between those with different experiences in actual decision making. However, we found that those who experienced the same level of involvement as they had

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