In-Person, Virtual Consults On Par in Achieving Shared Decision-Making

January 23, 2023 - A large observational study led by Vanderbilt University Medical Center researchers found that despite some challenges, the use of telehealth services for first-time surgery consultations resulted in similar levels of shared decision-making as in-person consultations.

As a result of the COVID-19 pandemic, telehealth use has grown, and its use in various clinical care areas continues. But researchers from Vanderbilt University Medical Center in Nashville, Tennesse, noted that its relationship with achieving the necessary levels of shared decision-making between patients and clinicians — a key aspect of providing quality care — is an understudied subject. Thus, they decided to compare the level of shared decision-making and the quality of communication between video and in-patient visits for first-time surgery consultations. The study was published in the Journal of the American College of Surgeons. 

The study included 387 patients, 301 of whom participated in an in-person visit and 86 in a telehealth visit between May 2021 and June 2022. Prior to the study, researchers hypothesized that telehealth would not achieve the same level of efficacy with regard to shared decision-making as in-person care.

Researchers used a validated questionnaire known as the collaboRATE Top Box to evaluate the level of shared decision-making and the 9-item Shared Decision-Making Questionnaire to determine patient satisfaction.

Following an adjusted analysis, they found that shared decision-making levels and communication quality did not differ between the in-person and virtual care groups. When faced with open-ended questions regarding telehealth experiences, positive patient comments mainly revolved around convenience and usefulness, and negative comments related to the lack of physical presence and technical difficulties.

“I was surprised by the qualitative responses. I expected that telemedicine visits would result in an inferior quality of communication," said study co-author Thomas Ueland, a third-year medical student at Vanderbilt University School of Medicine, in a press release. "While we did see that in some responses, we also saw some very positive perspectives on telemedicine visits both in terms of how the actual interaction went and the overall convenience of the process. Many patients really enjoyed having this as an option,”

But researchers also noted several limitations in the study, such as the non-response rate from participants being over 50 percent and the patient population being mainly in middle Tennessee, southern Kentucky, and northern Alabama.

In the future, researchers plan to conduct studies to determine condition-specific guides for when telemedicine should be used for surgery consultations instead of in-person visits.

"The data we generated in this study do give folks support, so that if they prefer telehealth appointments, they can be confident that they will not be sacrificing quality of communication or shared decision-making," said study co-author Alexander T. Hawkins, MD, associate professor of surgery at Vanderbilt University Medical Center, in the press release.

This is not the first study to show similar outcomes between telehealth and in-person visits.

A study published in May 2022 found that emergency room follow-up rates were similar following telehealth and in-person visits. During the investigation, researchers reviewed unplanned hospitalization and follow-up emergency department visit rates for various conditions. They found that the rates were similar between in-person and virtual visits within 14 days of the initial visit.

However, they found that telehealth patients often had higher rates of emergency department follow-up visits for a few conditions, like respiratory infection and pharyngitis. They also noted that patients between 18 and 34 years old were the most likely to use telehealth compared to other age groups.