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153 The effectiveness of shared decision making in rehabilitation options for vulnerable fracture patients after surgery
  1. Yi-Ling Lin,
  2. Shih-Tan Ting,
  3. Hsiu-Yun Liu,
  4. Hui-Ya Chan
  1. Department of Nursing, National Taiwan University Hospital, Taipei, Taiwan

Abstract

Introduction Three rehabilitation projects were proven to decrease disability and complication for patients with vulnerable fractures after surgery in Taiwan. The study aims to evaluate utilizing shared decision-making (SDM) and patient decision aids (PDA) to help these patients choose the rehabilitation project options.

Method The PDA is designed especially for patients with vulnerable fractures in the post-acute stage. Rehabilitation information through PDA was implemented during the SDM process. SDM includes explaining the details of each rehabilitation project, reviewing the post-acute needs of patients and caregivers, and determining their preferred rehabilitation project. An effective questionnaire is evaluated to understand patients’ and caregivers’ level of comprehension about before and after SDM.

Results From 2020 to 2022, a total of 134 orthopedic patients were recruited in this study. During the SDM process, 94(70.1%) patients immediately confirmed their rehabilitation options, and 40(29.9%) did not. Notably, after using the PDA in the SDM process, the patients’ scores for understanding the whole content of the PDA increased from 2.50 to 4.69. The consistent rate is around 87.1% to 92.9% of the 94 patients’ rehabilitation options and destination after hospital discharge.

Discussion Patients with vulnerable fractures would be discharged shortly after surgery. The study indicated that a well-designed PDA is significant for choosing rehabilitation options. A higher consistent rate could be obtained from any thorough SDM communication process if sufficient time is sufficient.

Conclusion(s) The study shows the effectiveness of using PDA to help patients and families understand their rehabilitation options, and most of all make a decision consistent with their ultimate destination. It suggests comparing more PDAs for those similar patient groups to improve the consistency rate between the immediate and final decision.

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