Patients Seek Active Role in Carpal Tunnel Decision Making

Patients who are to receive treatment for carpal tunnel syndrome (CTS) prefer to collaborate with their physician in decision making about their medical or surgical care, according to study results reported in a recent issue of the Journal of Bone and Joint Surgery, the official scientific journal of the American Academy of Orthopaedic Surgeons (AAOS). Patients with potentially life-threatening conditions, such as cancer, often prefer a more passive role in decision making, it was noted, but in conditions that involve quality-of-life issues, most patients prefer a more active role.

In the study, 78 patients who underwent carpal tunnel release for CTS were asked to indicate their preferred level of involvement preoperatively and to assess their actual levels of involvement postoperatively, using a scale that contained 5 levels, from fully active to fully passive. The results showed that patients were more likely to assume an active role in the decision-making process if they had undergone 1 or more previous surgical procedures, had a caregiver, or had additional private insurance to help defray treatment costs.

Previous studies have described various approaches to medical decision making, it was noted. The 3 primary models are as follows:

•Paternalistic. Physicians make decisions on the basis of what they think is in the patient’s best interest. Minimal information is conveyed to the patient.

•Consumerist. Physicians provide the information that patients need to make their own decisions.

•Shared decision-making, or collaborative. The physician and patient make decisions together and exchange medical and other information related to the patient’s health.

The investigators suggested that previous studies have shown that shared decision making leads to greater patient satisfaction in medical or surgical treatment. The current study showed that most patients want to share decision making with their physicians, an approach in which their cultural traditions, personal preferences and values, family situations, social circumstances, and lifestyles are considered in the process.

For more information, visit the AAOS Web site at http://www.aaos.org. Or, contact the organization at American Academy of Orthopaedic Surgeons, 6300 North River Road, Rosemont, IL 60018-4262; telephone: (847) 823-7186; fax: (847) 823-8125.