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Master of Public Health

Shared Decision-Making in General Surgery: A Prospective Comparison of Telemedicine vs In-Person Visits

AUTHORS

Hawkins AT , Ueland T , Aher C , Geiger TM , Spann MD , Horst SN , Schafer IV , Ye F , Fan R , Sharp KW , . Journal of the American College of Surgeons. 2023 1 19; ().

ABSTRACT

BACKGROUND: The Covid-19 pandemic has accelerated a shift towards virtual telemedicine appointments with surgeons. While this form of healthcare delivery has potential benefits for both patients and surgeons, the quality of these interactions remains largely unstudied. We hypothesized that telemedicine visits will be associated with lower quality of shared decision-making.

STUDY DESIGN: We performed a mixed-methods, prospective observational cohort trial. All patients presenting for a first-time visit at general surgery clinics between May 2021 and June 2022 were included. Patients were categorized by type of visit: in-person vs telemedicine. The primary outcome was level of shared decision-making as captured by Top Box score of the collaboRATE measure. Secondary outcomes included quality of shared decision-making as captured by the 9-item Shared Decision-Making Questionnaire (SDM-Q-9) and satisfaction with consultation. An adjusted analysis was performed accounting for potential confounders. A qualitative analysis of open-ended questions for both patients and practitioners was performed.

RESULTS: Over a 13-month study period, 387 patients were enrolled. 301 (77.8%) underwent an in-person visit and 86 (22.2%) underwent a telemedicine visit. The groups were similar in age, gender, employment, education, and generic quality of life scores. In an adjusted analysis, a visit type of telemedicine was not associated with either the collaboRATE TopBox score (OR 1.27; 95% CI 0.74-2.20) or SDM-Q-9 (β -0.60; p =0.76). Similarly, there was no difference in other outcomes. Themes from qualitative patient and surgeon responses included physical presence, time investment, appropriateness for visit purpose, technical difficulties, and communication quality.

CONCLUSION: In this large, prospective study, there does not appear to be a difference in quality of shared decision making in patients undergoing in-person vs telemedicine appointments.

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