A Survey-Based Assessment of Treatment Preferences for Distal Radius Fractures in Participants Aged 65 Years and Older.

PURPOSE: The management of distal radius fractures (DRF) in patients aged ≥65 years is debated because there is evidence that operative and nonsurgical treatment yield similar outcomes 1 year after injury. When more than one reasonable treatment option exists, shared decision-making between the patient and physician should be used. This study elicited preferences for the treatment of DRF using a survey of participants aged ≥65 years.

METHODS

A survey for participants ≥65 years was administered using Amazon Mechanical Turk. Participants were presented with a theoretical scenario in which they sustained a DRF, followed by two treatment options (surgery or casting) and evidence-based information on benefits, risks, and outcomes. Participants then responded to a series of 12 statements regarding the treatment options, rating their level of agreement on a Likert scale. At the end of the survey, they were asked to select their preferred treatment option.

RESULTS

There were 393 respondents that met inclusion criteria, and 74% were men. Fifty-three percent reported a prior history of a wrist fracture, with 84% of those participants undergoing surgery. Thirty-nine percent strongly agreed that avoiding surgical risks is an important part of their decision, and 36% strongly agreed that they were willing to accept a longer time in a cast. Despite this, 82% of participants selected surgery as their preferred treatment for a theoretical DRF.

CONCLUSIONS

Although most participants selected surgery as their preferred treatment, many responses regarding individual treatment factors aligned with nonsurgical treatment. This may be attributed to participants' belief that surgery leads to better outcomes or may highlight a disconnect between participants' values and their treatment choice.

CLINICAL RELEVANCE: The results of this study can be used to facilitate shared decision-making conversations regarding the treatment of DRF in this patient population.