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268 Shared decision making in the treatment of uncomplicated gallstone disease
  1. Martin Treider1,
  2. Jürgen Kasper2,
  3. Thomas J Fyhn1,
  4. Tom Glomsaker1,
  5. Magnus Fasting1,
  6. Tom Mala1,
  7. Simone Kienlin3
  1. 1Oslo University Hospital, department for gastrointestinal surgery
  2. 2Faculty of Health Sciences, Department of Nursing and Health Promotion, OsloMet Metropolitan University, Oslo, Norway
  3. 3The South-Eastern Norway Regional Health Authority, Department of Medicine and Healthcare, Hamar, Norway

Abstract

Introduction Policy interest in shared decision-making (SDM) is growing, leading to demands for quality indicators to monitor the ongoing implementation efforts. For uncomplicated gallstone disease, both surgical (cholecystectomy) and conservative treatments are safe options, and the patient‘s symptoms and preferences must be considered when choosing a treatment strategy. This study aimed to investigate the extent to which the patient is involved in the decision regarding treatment strategy.

Method The prospective study was conducted at the outpatient clinic at the Department of Gastrointestinal Surgery at Oslo University Hospital Ullevål. All patients referred with uncomplicated gallstone disease were invited to participate. Consultations were recorded on video and assessed by two experts.

Physicians, patients, and experts completed an SDM scoring questionnaire (MAPPIN SDM). MAPPIN SDM score is the average of 11 indicators scored from 0–4.

Results Of 34 eligible patients, 26 consented to participate in the study, 68% were women and the mean age was 47.8 (SD=16.1) years. The overall mean MAPPIN SDM score was 2.6 (SD=0.48). The mean scores for patients (3.5, SD=0.48) and doctors (2.9, SD=0.56) were similar, while the observer score (1.55, SD=0.65) was lower (p<0.001). The total mean MAPPIN SDM score for the 14 (54%) patients undergoing surgery was significantly higher than for those not undergoing surgery (2.89 and 2.28, p<0.001). The extent of patient involvement was positively associated with the strength of recommendation for surgery (r=0.67;p<0.001).

Discussion The non-redundance of different perspectives on patient involvement is a known phenomenon, implying that different perspectives measure different things. In addition, the result that involvement is facilitated through strong preferences on the doctors’ side needs interpretation.

Conclusion The study demonstrates moderate levels of patient involvement in decisions regarding uncomplicated gallstone disease. These findings imply the need for facilitating interventions to increase SDM in the treatment of uncomplicated gallstone disease.

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