DO PATIENTS REALLY VALUE SHARED DECISION-MAKING? A PILOT CONTINGENT VALUATION STUDY

Purpose: While there is growing evidence highlighting the benefits of shared decision-making (SDM), the value patients place on this process and what they would be willing to sacrifice are unclear. This study asked people to trade wait time for a consultation that offered SDM.

Methods: We conducted an online survey in which participants (n=200) were asked to imagine they had knee osteoarthritis and required a surgical consultation leading to one of two treatment options: knee replacement surgery or a combination of medication and exercise. Participants were told that the level of SDM employed by the surgeon would influence both (a) how well the options were presented, and (b) the likelihood of receiving the option most congruent with their values. The main explanatory variable was the surgeon's level of SDM, based on descriptive levels of the CollaboRATE scale (no, some, much SDM effort). The second explanatory variable was severity of knee pain while waiting (mild, moderate, severe). For each question, respondents could choose between waiting 12 weeks to see Surgeon A, who provided “no” SDM effort, or Surgeon B who offered “some” or “much” effort. Respondents were asked for the maximum number of weeks they would be willing to wait for Surgeon B. Repeated measures Poisson regression was used to determine the willingness to wait based on SDM effort and knee pain, adjusted for demographic variables.

Results: 151 individuals provided useable responses. The sample was 61% male, 47% university-educated, and 77% under health insurance. Results suggest that people are willing to wait longer for an increased level of SDM (Figure 1). This effect was modified by knee pain, with a lesser degree of pain associated with an increased willingness to wait (varying from 10.1 additional weeks for “mild” pain and “much” SDM effort to 1.9 additional weeks for “severe” pain and “some” SDM effort).

Conclusions: Implementing SDM is likely to involve upfront costs, thus policy makers must determine whether the benefits outweigh the costs. These findings suggest that people do value SDM: on average, respondents were willing to wait additional time in pain for a SDM consultation.  One possible interpretation is that participants equated greater SDM effort with better health outcomes. The meaning of SDM, and patients' expectations for SDM, need further exploration.