There is an increasing trend towards sharing the different treatment options with the patient and involving the patient in treatment decision-making [1,2,3,4,5,6,7]. This study demonstrates that doctors can significantly influence a patient’s decision depending on the content of the information provided. In rotator cuff disorders, most patients agree to receive surgery if the doctor presents information covering the basis of the benefits of surgery. On the other hand, most patients refuse to receive surgery if information is provided based on the negative outcomes of surgery, such as the cuff may be torn again at 2-year follow-up.
Not all physicians are in favor of involving patients in treatment decisions, especially less-experienced physicians. They are the ones who more frequently report barriers to involving patients [13]. Another commonly expressed barrier is the lack of time to share treatment decisions [13]. Nevertheless, it has been demonstrated that physicians are poor at assessing a patient’s preferences and that informed patients often tend to choose treatment strategies other than what the doctors suggest [11, 19].
From the patient’s perspective, not all want to be involved in treatment decision-making. Factors such as age, gender, educational level, urban or rural residence, and the severity of the illness play an important role in the decision [4, 9]. The Control preferences scale has been widely used to determine if the patient prefers an active, passive, or collaborative role in treatment decision [20]. Working on patient-reported outcomes rather than on functional scores and sharing this information with the patients as well as using it in the treatment decision-making process may be the path for the future [1].
There is no consensus about the best treatment strategy for rotator cuff disorders [21, 22]. While some authors recommend conservative treatment, others advocate for surgical repair of the torn cuff [8]. Among others, the re-tear rate after surgical treatment is a common complication that can impair outcomes [17]. Indications for rotator cuff repair have been defined from the physician’s perspective. These include age, gender, range-of-motion, weakness in forward elevation, tear size, and worker’s compensation status [8, 23, 24]. There is a lack of agreement among orthopedic surgeons relative to the indications for rotator cuff surgery. Surgeons who perform a higher volume of cuff repairs are more likely to agree to perform surgery [4]. From the patient’s perspective, psychological distress, depression, anxiety, and mental health seem to affect the outcome of rotator cuff treatments [24,25,26,27,28]. Moreover, whenever patient expectations were met after cuff repair, satisfaction, and quality of life improved [29, 30].
After all the aforementioned, it seems logical to involve the patient in the treatment decision-making for rotator cuff disorders but little attention has been paid to the way doctors inform patients so as to reach a decision. In the present study, it has been demonstrated that doctors can significantly influence a patient’s decision regarding rotator cuff surgery depending on the way they deliver the information. If information is presented based on the benefits of rotator cuff surgery, the majority of patients may accept surgery. Then again, most patients may refuse surgery if the information given focuses on the disadvantages of surgery. We cannot go about sharing information with patients and/or involving them in treatment decisions unless we are able to properly structure the information we provide and be sure that the information itself will not create a biased decision. It has been demonstrated, in urologic disorders, that the adverse effect profile of treatment is very important when deciding on the management of benign diseases, whereas treatment efficacy is more relevant in the management of life-threatening illness [10]. Full surgical information, including the characteristics of the arthroscopic technique, total length that the patient will need to be in-hospital until discharge, immobilization period, expected length of the rehabilitation process, and the time expected to fully recover and eventually to return to work, should be carefully explained to the patient.
In the present study, the level of pain or functional impairment, recorded using the Constant score, did not significantly differ between patients accepting or rejecting surgery. This suggests that the way that information is provided has a stronger influence on a patient’s treatment decision than the pain or functional impairment that the patient perceives. In the same manner, age, gender, and the shoulder affected did not significantly affect patients’ treatment decisions.
More research is needed on advising how to give information to patients and share treatment decision-making in rotator cuff disorders. Additionally, the development of decision-making support tools to help patients to make a decision for surgery or not in rotator cuff disorders should be considered as a potential solution.
The limitations of the study include the arbitrary selection of the Boileau et al. study to obtain the data to construct the question and that many factors can influence a patient’s decision. Despite these limitations, the randomized nature of the study provided a relatively equal distribution of various characteristics in both study groups that could potentially affect patient decisions. According to the sample size calculation, 40 patients were needed in each group. Eighty patients were included. Because of the randomization process, group A had 43 patients and group B had 37 patients, but the differences between both groups were wide enough to accept 37 patients in group B.
