The association between patients' preferred treatment after the use of a patient decision aid and their choice of eventual treatment

• Published in: Health expectations : an international journal of public participation in health care and health policy 2020-06, Vol.23 (3), p.651-658
• Main Authors: Latenstein, Carmen S. S., Thunnissen, Floris M., Thomeer, Bastiaan J. M., Wely, Bob J., Meinders, Marjan J., Elwyn, Glyn, Reuver, Philip R.
• Format: Article
• Language: English
• Subjects: Age; Calculi; Care and treatment; Clinical decision making; Comparative analysis; Complications; Decision making; Family physicians; Gallstones; general surgery; Handheld computers; Hernia; Hernias; Hospitals; Identification methods; Medical research; Medicine, Experimental; Original Research Paper; Original Research Papers; Outpatient care facilities; Pain; patient decision aid; Patients; patients' preference; Performance prediction; Preferences; Regression analysis; shared decision making; Surgery; Surgical outcomes
• ISSN: 1369-6513; 1369-7625
• DOI: 10.1111/hex.13045

Objective To investigate the association between patients' preferred treatment and eventual treatment. Second, to compare patients with surgical treatment to watchful waiting in order to identify predictive factors for surgery. Methods A single‐centre retrospective study was performed between December 2015 and August 2018. Patients (≥18 years) who used a patient decision aid (PDA) for gallstones or inguinal hernia were included. After their first surgical consultation, patients received access to an online PDA. The patients' preferred treatment after the PDA was compared with their choice of eventual treatment. Multivariable regression analyses were performed for predictive factors for surgery. Results In total, 567 patients with gallstones and 585 patients with an inguinal hernia were included. Of the patients with gallstones, 121 (21%) preferred watchful waiting, 367 (65%) preferred surgery, and 79 (14%) were not sure. The patients' preferred treatment was performed in 85.9%. Frequent pain attacks (OR 2.1, 95% CI 1.1‐3.9, P = .020) and preference for surgery (OR 4.4, 95% CI 1.9‐10.1, P = .001) independently predicted surgery. Of the patients with an inguinal hernia, 77 (13.2%) preferred watchful waiting, 452 (78.8%) preferred surgery, and 56 (9.6%) were not sure. The patients' preferred treatment was performed in 86.0%. The preference for surgery (OR 5.2, 95% CI 2.5‐10.6, P