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Pilot Survey of Shared Decision-Making Between Orthopaedic Surgeons and Their Patients in Guatemala

Background: Shared decision-making (SDM) is widely accepted as an essential feature of patient-centered care. However, to our knowledge, there has been no empirical research on the factors that influence orthopaedic surgeons’ use of SDM in Guatemala. Methods: Questions about physician attributes and SDM were included in a 2016 electronic survey distributed to the 221 members of the Asociación Guatemalteca de Ortopedia y Traumatología (AGOT). Results: A total of 114 (52%) of the AGOT-registered orthopaedic surgery residents and orthopaedic surgeons who were sent surveys returned them, and 79 of these surveys contained complete responses to study variables of interest. Of the 79 participants with complete responses, 73% reported that they discussed treatment options most of the time or always with their patients and 81% reported that they explained the reasons for treatment choices. Compared with residents, surgeons who had completed their residency in orthopaedic surgery or had subspecialty training had greater odds (odds ratio [OR] = 9.62; 95% confidence interval [CI] = 1.35, 68.53; p < 0.05) of explaining the reasons for their decisions rather than using other strategies when patients expressed different preferences. Residents and surgeons who discussed treatment choices with their patients were more likely to allow their patients to participate in treatment decisions than those who did not (OR = 2.88; 95% CI = 1.90, 4.36; p < 0.001). Conclusions: While findings from this exploratory study are limited by its small sample size and its narrow focus on physicians rather than on both patients and physicians, they nonetheless establish a roadmap for future study, particularly with respect to challenges in Guatemala to meaningful SDM that arise from context-specific cultural norms and practices. Clinical Relevance: SDM as a tool of practice remains underutilized by orthopaedic surgeons in clinical practice in Guatemala. This study may encourage more discussions regarding SDM in orthopaedic surgery elsewhere in Central America and prompt discussion in the region on the value of and need for postgraduate training in this area.