scholarly journals Evaluation of decision-making in the treatment of acetabular fractures

2022 ◽  
Vol 7 (1) ◽  
pp. 84-94
Author(s):  
Christof Audretsch ◽  
Alexander Trulson ◽  
Andreas Höch ◽  
Steven C Herath ◽  
Tina Histing ◽  
...  
Keyword(s):  
Decision Making ◽  
Surgical Treatment ◽  
Surgical Therapy ◽  
Injury Severity ◽  
Early Mobilization ◽  
Treatment Decision ◽  
Pelvic Surgery ◽  
Acetabular Fractures ◽  
List Type ◽  
Fracture Classification

Treatment of acetabular fractures is challenging and risky, especially when surgery is performed. Yet, stability and congruity of the hip joint need to be achieved to ensure early mobilization, painlessness, and good function. Therefore, coming up with an accurate decision, whether surgical treatment is indicated or not, is the key to successful therapy. Data from the German pelvic Trauma Registry (n  = 4213) was evaluated retrospectively, especially regarding predictors for surgery. Furthermore, a logistic regression model with surgical treatment as the dependent variable was established. In total, 25.8% of all registered patients suffered from an acetabular fracture and 61.9% of them underwent surgery. The fracture classification is important for the indication of surgical therapy. Anterior wall fractures were treated surgically in 10.2%, and posterior column plus posterior wall fractures were operated on in 90.2%. Also, larger fracture gaps were treated surgically more often than fractures with smaller gaps (>3 mm 84.4%, <1 mm 20%). In total, 51.4% of women and 66.0% of men underwent surgery. Apart from the injury severity score (ISS), factors that characterize the overall picture of the injury were of no importance for the indication of a surgical therapy (isolated pelvic fracture: 62.0%, polytrauma: 58.8%). The most frequent reason for non-operative treatment was ‘minimal displacement’ in 42.2%. Besides fracture classification and fracture characteristics, no factors characterizing the overall injury, except for the ISS, and unexpectedly gender, are important for making a treatment decision. Further studies are needed to determine the relevance of these factors, and whether they should be used for the decision-making process, in particular surgeons with less experience in pelvic surgery, can orient themselves to.

Patient and surgeon correlates of shared decision making for surgical breast cancer treatment

2006 ◽  
Vol 24 (18_suppl) ◽  
pp. 6031-6031
Author(s):  
S. Hawley ◽  
P. Lantz ◽  
B. Salem ◽  
A. Fagerlin ◽  
N. Janz ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Decision Making ◽  
Surgical Treatment ◽  
Cancer Treatment ◽  
Treatment Decision ◽  
Breast Conserving Surgery ◽  
Breast Cancer Treatment ◽  
Shared Decision ◽  
Treatment Decision Making ◽  
The Right

6031 Background: The choice of surgical breast cancer treatment represents an opportunity for shared decision making (SDM), since both mastectomy and breast conserving surgery are viable options. Yet women vary in their desire for involvement in this decision. Correlates of SDM and/or the level of involvement in breast cancer surgical treatment decision-making are not known. Methods: Breast cancer patients of Detroit and Los Angeles SEER registries were mailed a questionnaire shortly after diagnosis in 2002 (N = 1,800, RR: 77%). Their responses were merged with a surgeon survey (N = 456, RR: 80%) for a dataset of 1,547 patients of 318 surgeons. Surgical treatment decision making was categorized into: 1) surgeon-based; 2) shared; or 3) patient-based. The concordance between a woman’s self-reported actual and desired decisional involvement was categorized as having more, less, or the right amount of involvement. Decision making and concordance were each analyzed as three-level dependent variables using multinomial logistic regression controlling for clustering within surgeons. Independent variables included patient clinical, treatment and demographic factors, surgeon demographic and practice-related factors, and a measure of surgeon-patient communication. Results: 37% of women reported the surgery decision was shared, 25% that it was surgeon-based, and 38% that it was patient-based. Two-thirds experienced the right amount of involvement, while 13% had less and 19% had more. Compared to women who reported a shared decision, those with surgeon-based decision were significantly (p < 0.05) more likely to have male surgeons, and those reporting a patient-based decision were more likely to have received mastectomy vs. breast conserving surgery. Women who were less involved in the surgery decision than they wanted were younger and had less education, while those with more involvement (vs. the right amount) more often had male surgeons. Patient-surgeon communication was associated with decisional involvement. Conclusions: Correlates of SDM and decisional involvement relating to surgical breast cancer treatment differ. Determining patients’ desired role in decision making may as important as achieving a shared decision for evaluating perceived quality of care. No significant financial relationships to disclose.

scholarly journals Factors associated with patient involvement in surgical treatment decision making for breast cancer

2007 ◽  
Vol 65 (3) ◽  
pp. 387-395 ◽  
Author(s):  
Sarah T. Hawley ◽  
Paula M. Lantz ◽  
Nancy K. Janz ◽  
Barbara Salem ◽  
Monica Morrow ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Decision Making ◽  
Surgical Treatment ◽  
Patient Involvement ◽  
Treatment Decision ◽  
Factors Associated ◽  
Treatment Decision Making

Latina patient perspectives about informed decision making for surgical breast cancer treatment

2007 ◽  
Vol 25 (18_suppl) ◽  
pp. 6544-6544
Author(s):  
S. Hawley ◽  
N. Janz ◽  
A. Hamilton ◽  
S. J. Katz
Keyword(s):  
Breast Cancer ◽  
Decision Making ◽  
Surgical Treatment ◽  
Cancer Treatment ◽  
Treatment Decision ◽  
Breast Cancer Treatment ◽  
Informed Decision ◽  
Informed Decision Making ◽  
Decisional Satisfaction ◽  
Decisional Regret

6544 Background: Although increasing informed decision making has been identified as a mechanism for reducing disparities in breast cancer treatment outcomes, little is known about these issues from the Latina perspective. Methods: 2,030 women with non- metastatic breast cancer diagnosed from 8/05–5/06 and reported to the Los Angeles County SEER registry were identified and mailed a survey shortly after receipt of surgical treatment. Latina and African American women were over-sampled. Survey data were merged to SEER clinical data. We report results on a 50% respondent sample (N=742) which will be updated based on a final respondent sample of 1,400 patients (projected response rate, 72%). Dependent variables were patient reports of how decisions were made (doctor-based, shared, patient-based); their preferred amount of decisional involvement; and two 5-item scales measuring satisfaction with decision-making and decisional regret. Results: 32% of women were white, 28% African American (AA), 20% Latina-English speaking (L-E), and 20% Latina-Spanish speaking (L- SP). About 28% of women in each ethnic group reported a surgeon-based, 33% a shared, and 38% a patient-based surgical treatment decision. L- SP women reported wanting more involvement in decision making more often than white, AA or L-E women (16% vs. 4%, 5%, 5%, respectively, p<0.001). All minority groups were less likely than white women to have high decisional satisfaction with L-SP women having the lowest satisfaction (w-74%, AA-63%, L-E-56%, L-SP-31%, p<0.001). L-SP women were more likely than white, AA or L-E women to have decisional regret (35% vs. 7%, 15%, 16%, respectively, p<0.001). Multivariate regression showed that Latina ethnicity and low literacy were independently associated with both low decisional satisfaction and high decisional regret (p<0.001). Conclusions: Latina women, especially Spanish speakers, report more dissatisfaction with the breast cancer surgical treatment decision-making process than other racial/ethnic groups. These results highlight the challenges to improving breast cancer treatment informed decision making for Latina women. Future interventions to improve satisfaction with the decision process should be tailored to ethnicity and acculturation. No significant financial relationships to disclose.

scholarly journals Patient Participation in Surgical Treatment Decision Making from the Patients' Perspective: Validation of an Instrument

2012 ◽  
Vol 2012 ◽  
pp. 1-8 ◽  
Author(s):  
Liv-Helen Heggland ◽  
Torvald Øgaard ◽  
Aslaug Mikkelsen ◽  
Kjell Hausken
Keyword(s):  
Decision Making ◽  
Surgical Treatment ◽  
Patient Participation ◽  
Information Dissemination ◽  
Psychometric Testing ◽  
Treatment Decision ◽  
Validity And Reliability ◽  
Treatment Decision Making ◽  
And Control ◽  
Patients Perspective

The aim of this paper is to describe the development of a new, brief, easy-to-administer self-reported instrument designed to assess patient participation in decision making in surgical treatment. We describe item generation, psychometric testing, and validity of the instrument. The final scale consisted of four factors: information dissemination (5 items), formulation of options (4 items), integration of information (4 items), and control (3 items). The analysis demonstrated a reasonable level of construct validity and reliability. The instrument applies to patients in surgical wards and can be used to identify the health services that are being provided and the areas that could strengthen patient participation.

Is contralateral prophylactic mastectomy (CPM) overused? Results from a population-based study.

2012 ◽  
Vol 30 (34_suppl) ◽  
pp. 26-26 ◽  
Author(s):  
Sarah T. Hawley ◽  
Reshma Jagsi ◽  
Steven J. Katz
Keyword(s):  
Breast Cancer ◽  
Decision Making ◽  
Surgical Treatment ◽  
Family History ◽  
Genetic Test ◽  
Significant Risk ◽  
Treatment Decision ◽  
Clinical Indication ◽  
Clinically Significant ◽  
Worry About Recurrence

26 Background: The growing rate of CPM among women diagnosed with breast cancer has raised concerns about potential for over-treatment yet, little is known about factors that affect the decisions for this surgical treatment option. Methods: We surveyed 2,245 women newly diagnosed with breast cancer and reported to the Detroit and Los Angeles SEER registries from 6/05-2/07. We merged these data to SEER and re-surveyed them again approximately 4 years later (n=1,525). The primary outcome was receipt of CPM. We modeled surgical treatment decision making in two stages: any mastectomy (including CPM) vs. lumpectomy, and CPM vs. unilateral mastectomy (UM) among mastectomy-treated patients. The primary independent variable was clinically significant risk of developing contralateral disease (family history of at least 2 family members with breast cancer and/or a positive genetic test). We also evaluated the degree to which worry about recurrence drove initial treatment decisions (very vs. somewhat/not at all) and controlled for race/ethnicity, age, stage and SEER site. Results: Of the 1,446 women who had not had a recurrence of breast cancer by the time 2 survey, 35% considered CPM and 7.4% received it. Among those who received a mastectomy for the affected breast the figures were 53% and 19%, respectively. About 70% of patients who received CPM were clinically at very low risk for contralateral disease. 90% of those who got CPM reported being very worried about recurrence when making their treatment decision, compared to 80% of those who received UM (p<0.05). Multivariate regression showed that receipt of CPM vs. UM was associated with having a family history (OR 5.1; 95% CI: 2.49-10.1) and a positive genetic test (OR: 10.93; 95% CI: 3.37-35.71), but was also associated with greater worry about recurrence (OR: 2.07; 95% CI: 1.01-4.51). Conclusions: Many women considered CPM despite the fact that very few of them had clinically significant risk of contralateral breast cancer. Most women who had CPM did not have a clinical indication for considering it and thus not expected to benefit in terms of disease free survival. More research is needed about the underlying factors driving decision-making for CPM.

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