A Randomized Trial Measuring the Effect of Decision Aids on Patients' Satisfaction, Conflict of Decision-making and Clinical Outcome

A Randomized Trial Measuring the Effect of Decision Aids on Patients' Satisfaction, Conflict of Decision-making and Clinical Outcome

The investigators plan a prospective randomized controlled study that compares the treatment decisions made by patients who receive decision aids, as compared to patients treated with usual care and the American Society for Surgery of the Hand brochures. The investigators expect to enroll 126 patients.

Decision aids are tools that help patients participate in making decisions by providing detailed, specific, and personalized information regarding the benefits and risks of various potential treatment options for a diagnosis. Decision aids can reduce the level of uncertainty and mental anguish associated with choosing a particular course of action, i.e. 'decisional conflict'. The most common manifestations of decisional conflict include verbalized uncertainty about choices or undesired consequences of alternatives, vacillation between choices, and delayed decision making. Besides the advantages of decision aids in the process of decision-making, the literature is not conclusive about the effect of decision aids on patient satisfaction. Of the 86 randomized controlled trials identified by authors Stacey et al., eleven studies measured satisfaction. Of these, four studies reported that people exposed to decision aids had higher satisfaction with their choice compared to usual care, and the remaining seven reported no statistically significant difference. Studies that have directly investigated the effect of decision aids in orthopaedic practice are limited and further study is necessary to determine the best way to implement decision aids in a clinical orthopedic practice. 7-12 Randomized trials evaluating the impact of decision aids on patient knowledge, decisional conflict, satisfaction, and outcomes may have substantial impact in hand surgery where most treatments are elective and address quality of life.

Trapeziometacarpal Arthrosis, Carpal Tunnel Syndrome, Cubital Tunnel Syndrome, Distal Radius Fractures, Trigger Finger

One cohort will not receive the decision aid, and instead will receive only a brochure as standard treatment.

Cohort I will be managed with a decision aid (henceforth "DA"), and Cohort II will be managed without one. The patients in Cohort I will receive the DA, which they can complete in a separate room and take home. The decision aids include information on the disease/condition, treatment options, benefits, risks, scientific uncertainties, and probabilities of potential outcomes tailored to the patient's health risks factors. Additionally, it includes values clarifications such as describing outcomes in functional terms, asking patients to consider which benefits and risks matter most to them, and guidance in the steps of decision making and discussing their decision with family/friends. It is interactive and dynamic, helping patients clarify their preferences and come to a decision that feels best to them.

Change from baseline in Decision conflict scale (DCS), which quantifies the state of uncertainty about a course of action.

6-month Change in Decision conflict scale (DCS), which quantifies the state of uncertainty about a course of action.

The Acceptability questionnaire measures the acceptability of the decision aid, including the content of the decision aid. It refers to ratings regarding the comprehensibility of components of a decision aid, its length, amount of information, balance in presentation of information about options, and overall suitability for decision making.

6-week change from baseline in the 11-point ordinal satisfaction scale, which quantifies the satisfaction with overall treatment

6-month change from baseline in the 11-point ordinal satisfaction scale, which quantifies the satisfaction with overall treatment

6-week change in the 11-point ordinal satisfaction scale, which quantifies the satisfaction with decision-making.

6-month change in the 11-point ordinal satisfaction scale, which quantifies the satisfaction with decision-making.

6-week change in the Stage of decision making, which is meant to gauge patients' progress in making a treatment decision.

6-month change in the Stage of decision making, which is meant to gauge patients' progress in making a treatment decision.

6-week change in the knowledge questionnaire, which gauges patients' knowledge of their diagnosis and treatment options.

6-month change in the knowledge questionnaire, which gauges patients' knowledge of their diagnosis and treatment options.

6-week change in the Decision Self-Efficacy Scale, which measures patients' confidence in making treatment decisions.

6-month change in the Decision Self-Efficacy Scale, which measures patients' confidence in making treatment decisions.

6-week change in the Acceptability questionnaire, which measures the acceptability of the decision aid, including the content of the decision aid. It refers to ratings regarding the comprehensibility of components of a decision aid, its length, amount of information, balance in presentation of information about options, and overall suitability for decision making.

6-month change in the Acceptability questionnaire, which measures the acceptability of the decision aid, including the content of the decision aid. It refers to ratings regarding the comprehensibility of components of a decision aid, its length, amount of information, balance in presentation of information about options, and overall suitability for decision making.

Change from the baseline in the Disabilities of the Arm, Shoulder and Hand Quick Questionnaire (Quick-DASH) at 6 weeks

6-week change in the Quick-DASH, which measures the patient's ability to do following activities in the week before a visit.

Change from the baseline in the Disabilities of the Arm, Shoulder and Hand Quick Questionnaire (Quick-DASH) at 6 months

6-month change in the Quick-DASH, which measures the patient's ability to do following activities in the week before a visit.

Change in the Decision Regret Scale, which measures distress or remorse after a health care decision.

Inclusion Criteria: Age 18 and above Diagnosis of moderate or severe: 2.) Carpal Tunnel Syndrome (CTS) 5.) Trigger Finger (TF) Exclusion Criteria: Patients with previous interventions for CTS or TF Inability to complete enrollment forms due to any mental status or language problems (e.g. dementia, head injury, overall illness).