Do Patient Preferences Influence Surgeon Recommendations for Treatment?

Background: When the best treatment option is uncertain, a patient’s preference based on personal values should bethe source of most variation in diagnostic and therapeutic interventions. Unexplained surgeon-to-surgeon variation intreatment for hand and upper extremity conditions suggests that surgeon preferences have more influence than patientpreferences.Methods: A total of 184 surgeons reviewed 18 fictional scenarios of upper extremity conditions for which operativetreatment is discretionary and preference sensitive, and recommended either operative or non-operative treatment.To test the influence of six specific patient preferences the preference was randomly assigned to each scenario in anaffirmative or negative manner. Surgeon characteristics were collected for each participant.Results: Of the six preferences studied, four influenced surgeon recommendations. Surgeons were more likelyto recommend non-operative treatment when patients; preferred the least expensive treatment (adjusted OR,0.82; 95% CI, 0.71 – 0.94; P=0.005), preferred non-operative treatment (adjusted OR, 0.82; 95% CI, 0.72 – 0.95;P=0.006), were not concerned about aesthetics (adjusted OR, 1.15; 95% CI, 1.0 – 1.3; P=0.046), and when patientsonly preferred operative treatment if there is consensus among surgeons that operative treatment is a useful option(adjusted OR, 0.78; 95% CI, 0.68 – 0.89; P