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CTS Patients Want to be Involved in Care Decisions


Carpal tunnel syndrome (CTS) patients want to be involved in making decisions regarding their medical or surgical care, according to the findings of a study to be published in the August 17th issue of the Journal of Bone and Joint Surgery (JBJS).

Hyun Sik Gong, MD, PhD, study author and orthopaedic surgeon, noted “While other studies have shown patients with potentially life-threatening conditions such as cancer tend to prefer a more passive role when it comes to decision-making, this study demonstrates that in carpal tunnel syndrome, which raises issues of quality of life rather than those related to a life-threatening condition, the majority of patients preferred to share decision making with their physicians.”

Gong and colleagues surveyed 78 patients who underwent carpal tunnel release for CTS between May 2008 and December 2009. Prior to surgery, these patients were asked to indicate their preferred level of involvement. After surgery, they were asked to assess their actual levels of involvement. The surveys were done using a Control Preferences scale containing five levels ranging from fully active to fully passive.

Of the 78 patients, 71 were women and 7 were men. All were ethnically Korean. The median age 57 years of age (range 27 to 81 years).

Gong and colleagues found that 76% (59/78) of the patients indicated preoperatively a preference for shared decision-making. Interestingly, a larger number (66/78, 85%) felt postoperatively that they had experienced shared decision-making.

Patients were more likely to assume an active role in the decision-making process if they a history of having undergone one or more previous surgical procedures; had a caregiver; or had additional private insurance to help defray treatment costs.

“It is likely that the experience of a previous operation clarified uncertainties or conflicts regarding surgery, and that the presence of a caregiver allowed patients greater freedom during decision-making,” Dr. Gong noted.

Dr. Gong said that previous studies have described three primary approaches to medical decision-making:

The paternalistic model, in which physicians make decisions on the basis of what they believe to be in the patients’ best interest, and minimal information is conveyed from the physician to the patient;
The consumerist model, in which doctors provide the information that patients require to make their own decisions;
And the shared decision-making, or collaborative, model, in which the physician and patient make the decision together and exchange medical and other information related to the patient’s health. Dr. Gong added that previous studies have shown that this type of decision making leads to greater patient satisfaction in medical or surgical treatment.
“This study shows the majority of patients wanted to share decision-making with their physicians, and patients should feel comfortable asking questions and expressing their preferences regarding care. Patient-centered care emphasizes the incorporation of individual styles of decision making to provide a more patient-centered consultation,” Dr. Gong added.

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In a ‘patient-centered’ approach, patients’ cultural traditions, personal preferences and values, family situations, social circumstances and lifestyles are considered in the decision-making process.

Although the current study did not determine which type of role, if any, resulted in better surgical outcomes, Dr. Gong said a subsequent study is being conducted evaluating surgical outcomes and patients’ preferred levels of involvement.

Carpal tunnel syndrome typically starts gradually with a vague aching in your wrist that can extend to your hand or forearm. Other signs and symptoms of CTS include Tingling or numbness in your fingers or hand, especially your thumb and index, middle or ring fingers, but not your little finger; Pain radiating or extending from your wrist up your arm to your shoulder or down into your palm or fingers; and a sense of weakness in your hands and a tendency to drop objects.

Treatment options include wrist splinting, medications and surgery. Splinting and other conservative treatments are more likely to help you if you've had only mild to moderate symptoms for less than 10 months.

Patients considering treatment of carpal tunnel syndrome or any orthopaedic injury should feel comfortable with their provider’s level of involvement and not be afraid to ask questions or speak up, Dr. Gong noted.

The above story is reprinted (with editorial adaptations by Ramona Bates, MD) from materials provided by American Academy of Orthopaedic Surgeons (AAOS) and the below sources.

Patient’s Preferred and Retrospectively Perceived Levels of Involvement During Decision-Making Regarding Carpal Tunnel Release; Hyun Sik Gong, MD, PhD, Jung Kyu Huh, MD, Jung Ha Lee, MD, Min Bom Kim, MD, Moon Sang Chung, MD, PhD, and Goo Hyun Baek, MD, PhD; J. Bone Joint Surg. Am., Aug 2011; DOI: 10.2106/JBJS.J.00951

AAOS: Ask an Orthopaedic Surgeon about Carpal Tunnel Syndrome

Factors Affecting Willingness to Undergo Carpal Tunnel Release ; Hyun Sik Gong, MD, PhD, Goo Hyun Baek, MD, PhD, Joo Han Oh, MD, PhD, Young Ho Lee, MD, PhD, Suk Ha Jeon, MD, Moon Sang Chung, MD, PhD; J. Bone Joint Surg. Am., Sep 2009; 91 (9); 2130-2136. doi: 10.2106/JBJS.H.01221

American Academy of Orthopaedic Surgeons Clinical Practice Guideline on The Treatment of Carpal Tunnel Syndrome ; Michael Warren Keith, MD, Victoria Masear, MD, Kevin C. Chung, MD, MS, Peter C. Amadio, MD, Michael Andary, MD, Richard W. Barth, MD, Kent Maupin, MD, Brent Graham, MD, William C. Watters, MD, Charles M. Turkelson, PhD, Robert H. Haralson, MD, MBA, Janet L. Wies, MPH, Richard McGowan, MLS; J. Bone Joint Surg. Am., Jan 2010; 92 (1); 218-219. doi: 10.2106/JBJS.I.00642