Testing of a Tool to Elicit Patient Preferences for CTS

Carpal Tunnel Syndrome Clinical Trial

Official title:

Testing of a Tool to Elicit Patient Preferences for CTS

Clinical Trial Details — Status: Completed

Administrative data

• NCT number: NCT03532373
• Other study ID #: 46107
• Status: Completed
• Phase: N/A
• Start date: March 1, 2021
• Est. completion date: June 1, 2023

Study information

• Verified date: October 2023
• Source: Stanford University
• Contact: n/a
• Is FDA regulated: No
• Study type: Interventional

Clinical Trial Summary

This study will complete a randomized controlled trial to quantitatively measure patient decisional conflict (Decisional Conflict Scale) in 150 patients treated for CTS with the tool compared to 150 patients treated with standard care. The investigators hypothesize patients treated for CTS will have lower decisional conflict with the tool.

Description:

The investigators will measure decisional conflict in 150 new patients being evaluated for CTS with the tool compared to 150 patients being evaluated for CTS with standard care. Those patients randomized to receiving the tool will use it to identify their preferences for certain attributes of care. Patients will then be presented with their preference data and the surgeon will have a discussion with the patient regarding CTS. Surgeons will have their standard discussion with the patients randomized to the standard care group (no tool). The tool will be operationalized on a Health Insurance Portability and Accountability Act compliant data platform, such as Qualtrics, and no identifiable data will be collected. De-identified data will be shared from study cites with our team at Stanford. This data will be backed up on a computer encrypted by Stanford.

Recruitment information / eligibility

• Status: Completed
• Enrollment: 49
• Est. completion date: June 1, 2023
• Est. primary completion date: June 1, 2023
• Accepts healthy volunteers: No
• Gender: All
• Age group: 18 Years and older

Eligibility

Inclusion Criteria:

• New patient
• English fluency and literacy
• Able to take informed consent
• clinical diagnosis of carpal tunnel syndrome

Exclusion Criteria:

• Prior diagnostic testing for carpal tunnel (nerve test, ultrasound)
• Prior carpal tunnel release
• Diagnosis of C5/6 radiculopathy (double crush)
• Peripheral neuropathy (ex: diabetic)
• Worker Compensation/EMG Required
• Symptoms of Cubital tunnel syndrome

Related Conditions & MeSH terms

• Carpal Tunnel
• Carpal Tunnel Syndrome
• Carpal Tunnel Syndrome Bilateral
• Carpal Tunnel Syndrome Left
• Carpal Tunnel Syndrome Right
• Syndrome

Intervention

Other:
• Preference Elicitation tool
A preference elicitation tool for carpal tunnel syndrome

Locations

Country	Name	City	State
United States	Stanford Health Care	Redwood City	California

Sponsors (6)

Lead Sponsor	Collaborator
Stanford University	Brown University, Duke University, Harvard University, Mayo Clinic, University of Texas at Austin

Country where clinical trial is conducted

United States, 

References & Publications (25)

Alfandre D. Clinical Recommendations in Medical Practice: A Proposed Framework to Reduce Bias and Improve the Quality of Medical Decisions. J Clin Ethics. 2016 Spring;27(1):21-7. — View Citation

Atroshi I, Englund M, Turkiewicz A, Tagil M, Petersson IF. Incidence of physician-diagnosed carpal tunnel syndrome in the general population. Arch Intern Med. 2011 May 23;171(10):943-4. doi: 10.1001/archinternmed.2011.203. No abstract available. — View Citation

Baker LC, Bundorf MK, Kessler DP. Patients' preferences explain a small but significant share of regional variation in medicare spending. Health Aff (Millwood). 2014 Jun;33(6):957-63. doi: 10.1377/hlthaff.2013.1184. — View Citation

Elwyn G, Frosch D, Thomson R, Joseph-Williams N, Lloyd A, Kinnersley P, Cording E, Tomson D, Dodd C, Rollnick S, Edwards A, Barry M. Shared decision making: a model for clinical practice. J Gen Intern Med. 2012 Oct;27(10):1361-7. doi: 10.1007/s11606-012-2077-6. Epub 2012 May 23. — View Citation

Fajardo M, Kim SH, Szabo RM. Incidence of carpal tunnel release: trends and implications within the United States ambulatory care setting. J Hand Surg Am. 2012 Aug;37(8):1599-605. doi: 10.1016/j.jhsa.2012.04.035. Epub 2012 Jun 23. — View Citation

Flynn KE, Weinfurt KP, Seils DM, Lin L, Burnett CB, Schulman KA, Meropol NJ. Decisional conflict among patients who accept or decline participation in phase I oncology studies. J Empir Res Hum Res Ethics. 2008 Sep;3(3):69-77. doi: 10.1525/jer.2008.3.3.69. — View Citation

Fowler JR, Cipolli W, Hanson T. A Comparison of Three Diagnostic Tests for Carpal Tunnel Syndrome Using Latent Class Analysis. J Bone Joint Surg Am. 2015 Dec 2;97(23):1958-61. doi: 10.2106/JBJS.O.00476. — View Citation

Fraenkel L, Chodkowski D, Lim J, Garcia-Tsao G. Patients' preferences for treatment of hepatitis C. Med Decis Making. 2010 Jan-Feb;30(1):45-57. doi: 10.1177/0272989X09341588. Epub 2009 Jul 27. — View Citation

Graham B, Regehr G, Naglie G, Wright JG. Development and validation of diagnostic criteria for carpal tunnel syndrome. J Hand Surg Am. 2006 Jul-Aug;31(6):919-24. — View Citation

Graham B. The diagnosis and treatment of carpal tunnel syndrome. BMJ. 2006 Jun 24;332(7556):1463-4. doi: 10.1136/bmj.332.7556.1463. No abstract available. — View Citation

Graham B. The value added by electrodiagnostic testing in the diagnosis of carpal tunnel syndrome. J Bone Joint Surg Am. 2008 Dec;90(12):2587-93. doi: 10.2106/JBJS.G.01362. — View Citation

Hageman MG, Bossen JK, Neuhaus V, Mudgal CS, Ring D; Science of Variation Group. Assessment of Decisional Conflict about the Treatment of carpal tunnel syndrome, Comparing Patients and Physicians. Arch Bone Jt Surg. 2016 Apr;4(2):150-5. — View Citation

Hageman MG, Kinaci A, Ju K, Guitton TG, Mudgal CS, Ring D; Science of Variation Group. Carpal tunnel syndrome: assessment of surgeon and patient preferences and priorities for decision-making. J Hand Surg Am. 2014 Sep;39(9):1799-1804.e1. doi: 10.1016/j.jhsa.2014.05.035. Epub 2014 Aug 1. — View Citation

Hampson LA, Allen IE, Gaither TW, Lin T, Ting J, Osterberg EC, Wilson L, Breyer BN. Patient-centered Treatment Decisions for Urethral Stricture: Conjoint Analysis Improves Surgical Decision-making. Urology. 2017 Jan;99:246-253. doi: 10.1016/j.urology.2016.07.053. Epub 2016 Sep 16. — View Citation

Hyman DJ, Pavlik VN, Greisinger AJ, Chan W, Bayona J, Mansyur C, Simms V, Pool J. Effect of a physician uncertainty reduction intervention on blood pressure in uncontrolled hypertensives--a cluster randomized trial. J Gen Intern Med. 2012 Apr;27(4):413-9. doi: 10.1007/s11606-011-1888-1. Epub 2011 Oct 27. — View Citation

Johnson DC, Mueller DE, Deal AM, Dunn MW, Smith AB, Woods ME, Wallen EM, Pruthi RS, Nielsen ME. Integrating Patient Preference into Treatment Decisions for Men with Prostate Cancer at the Point of Care. J Urol. 2016 Dec;196(6):1640-1644. doi: 10.1016/j.juro.2016.06.082. Epub 2016 Jun 23. — View Citation

Kamal RN; Hand Surgery Quality Consortium. Quality and Value in an Evolving Health Care Landscape. J Hand Surg Am. 2016 Jul;41(7):794-9. doi: 10.1016/j.jhsa.2016.05.016. — View Citation

Keith MW, Masear V, Amadio PC, Andary M, Barth RW, Graham B, Chung K, Maupin K, Watters WC 3rd, Haralson RH 3rd, Turkelson CM, Wies JL, McGowan R. Treatment of carpal tunnel syndrome. J Am Acad Orthop Surg. 2009 Jun;17(6):397-405. doi: 10.5435/00124635-200906000-00008. — View Citation

Lang F, Floyd MR, Beine KL. Clues to patients' explanations and concerns about their illnesses. A call for active listening. Arch Fam Med. 2000 Mar;9(3):222-7. doi: 10.1001/archfami.9.3.222. — View Citation

Mulley AG, Trimble C, Elwyn G. Stop the silent misdiagnosis: patients' preferences matter. BMJ. 2012 Nov 8;345:e6572. doi: 10.1136/bmj.e6572. No abstract available. — View Citation

Newington L, Harris EC, Walker-Bone K. Carpal tunnel syndrome and work. Best Pract Res Clin Rheumatol. 2015 Jun;29(3):440-53. doi: 10.1016/j.berh.2015.04.026. Epub 2015 May 27. — View Citation

Oshima Lee E, Emanuel EJ. Shared decision making to improve care and reduce costs. N Engl J Med. 2013 Jan 3;368(1):6-8. doi: 10.1056/NEJMp1209500. No abstract available. — View Citation

Pulikkottil BJ, Schub M, Kadow TR, Wang W, Fowler JR. Correlating Median Nerve Cross-sectional Area With Nerve Conduction Studies. J Hand Surg Am. 2016 Oct;41(10):958-962. doi: 10.1016/j.jhsa.2016.08.018. — View Citation

Wittink MN, Cary M, Tenhave T, Baron J, Gallo JJ. TOWARDS PATIENT-CENTERED CARE FOR DEPRESSION: CONJOINT METHODS TO TAILOR TREATMENT BASED ON PREFERENCES. Patient. 2010;3(3):145-157. doi: 10.2165/11530660. — View Citation

Zhang S, Vora M, Harris AH, Baker L, Curtin C, Kamal RN. Cost-Minimization Analysis of Open and Endoscopic Carpal Tunnel Release. J Bone Joint Surg Am. 2016 Dec 7;98(23):1970-1977. doi: 10.2106/JBJS.16.00121. — View Citation

* Note: There are 25 references in all — Click here to view all references

Outcome

Type	Measure	Description	Time frame	Safety issue
Primary	Decisional Conflict Scale	Name: Decisional Conflict Scale Measures: uncertainty in choosing options; modifiable factors contributing to uncertainty such as feeling uninformed, unclear about personal values and unsupported in decision making; and effective decision making such as feeling the choice is informed, values-based, likely to be implemented and expressing satisfaction with the choice.; 16 statements with 5 response categories Scoring: total scale-0 (no decisional conflict) to 100 (extreme decisional conflict) lower values indicate lower decisional conflict- i.e. a better outcome for use of the tool.; Calculation: Summed, divided by # of items, multiplied by 25	Immediately after using tool