Patients Who Reviewed a Decision Aid Prior to Major Orthopaedic Surgery Reported Higher Trust in Their Surgeon

BACKGROUND: Decision aids (DAs) are utilized to ensure that patients are informed and involved in the decision-making process. Although DAs improve decision quality, other aspects of the decision-making process, such as trust and regret, are seldom measured. The objective of the present study was to determine whether patients given a DA prior to orthopaedic surgery had greater trust and lower regret at 6 months postoperatively. METHODS: Consecutive patients were identified who underwent a hip or knee replacement or spine surgery from October 2018 to January 2020 and were subsequently surveyed at 6 months postoperatively. Outcomes included the Trust in the Surgical Decision and Decision Regret Scales. The primary analysis compared scores of patients who reviewed at least some of the DA to those who had not received or reviewed it. A sensitivity analysis compared patients with a DA order who reported reviewing it to those who did not. Multivariable models analyzed whether DA exposure predicted trust or regret. An exploratory mediation analysis examined the direct and indirect effects of DA exposure, including through the Shared Decision Making Process score. RESULTS: The response rate was 56% (700 of 1,253). In the primary analysis, the proportion of patients who reported complete trust was 50.9% among those with no DA review and 63.8% among those with DA review (adjusted odds ratio, 1.62; 95% confidence interval, 1.11 to 2.36). A nonsignificant effect was observed comparing a DA order (59.9%) versus no DA order (51.4%; adjusted odds ratio, 1.30; 95% confidence interval, 0.80 to 2.11). Regret was unrelated to DA exposure. In the mediation analysis, 19.3% (95% confidence interval, 3.1% to 35.4%) of the effect of DA review on trust could be attributed to increased shared decision making. CONCLUSIONS: Patients who reviewed a DA prior to orthopaedic surgery reported higher trust in their surgeons. CLINICAL RELEVANCE: Providing patients with a DA prior to orthopaedic surgery can improve trust in the surgeon. Improving trust between patients and surgeons may improve communication and help patients make better health decisions.