Video-based Consensus Opinion for Hand and Upper Extremity Problems

The investigators would like to determine if there is a difference in patient satisfaction among patients who have puzzling pain conditions and receive one evaluation from their treating physician, and those that receive an evaluation from their treating physician and from a group of consulting physicians by video. The investigators expect to enroll 128 patients at Massachusetts General Hospital.

Study Overview

• Status: Withdrawn
• Conditions: Pain
• Intervention / Treatment: Behavioral: Video-based Consensus Opinion

Detailed Description

Before visiting a specialist, patients have assumptions regarding diagnosis, etiology, prognosis, and preferred treatment for their condition. Naturally, some of these assumptions may be inaccurate or incomplete or there may be room for debate and disagreement even among specialists. We are looking for ways to make unexpected and indeterminate aspects of an illness less unsettling for patients. When the hand surgeon's advice doesn't ring true, the patient may lose confidence in that provider. Sometimes the interaction can feel disrespectful and even adversarial. We are curious whether patient's satisfaction with diagnosis, surgeon, and treatment plan would improve if they were able to get an opinion from many surgeons at once. One feasible way to do that would be to show an edited and anonymized video to a set of hand surgeons for their opinions on diagnosis and treatment.

Primary study question:

1. Among patients with initially puzzling pains, there is no difference in satisfaction with diagnosis between patients that receive a video based consensus opinion and those that receive routine care from a single hand surgeon controlling for psychological factors, demographics, and initial and final diagnosis.

   Secondary study questions:

2. Among patients with initially puzzling pains, there is no difference in pain intensity and disability one month after the initial visit between patient that receive a consensus diagnosis and those that receive routine care from a single surgeon.
3. There is no variation in diagnosis between observers (Observers are hand surgeons viewing the visit video and consulting on the diagnosis).

• Study Type: Interventional
• Phase: Not Applicable

Contacts and Locations

Study Locations

• United States
  • Massachusetts
    • Boston, Massachusetts, United States, 02114
      • Massachusetts General Hospital

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: 18 years and older (Adult, Older Adult)
• Accepts Healthy Volunteers: No
• Genders Eligible for Study: All

Description

Inclusion Criteria:

• All patients (>18 years) presenting to Dr. David Ring with painful conditions that are puzzling (A puzzling pain condition is defined as Dr. Ring being puzzled about what is causing the pain. Subject eligibility based on this criterion will be determined by Dr. Ring).
• English fluency and literacy
• Able to provide informed consent

Exclusion Criteria:

• Pregnant Women

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Health Services Research
• Allocation: Non-Randomized
• Interventional Model: Single Group Assignment
• Masking: None (Open Label)

Number of Arms

2

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
No Intervention: Control; Visits are not videotaped
Experimental: Videoed Patients; Patients will have their visit videotaped.	Behavioral: Video-based Consensus Opinion

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Time Frame
Likert Scale for Satisfaction	At enrollment
Likert Scale for Satisfaction	4-6 weeks

Secondary Outcome Measures

Outcome Measure	Time Frame
Patient Self-Efficacy Questionnaire (PSEQ-2)	At enrollment
Patient Self-Efficacy Questionnaire (PSEQ-2)	4-6 weeks
Patient Health Questionnaire (PHQ-2)	at enrollment
Patient Health Questionnaire (PHQ-2)	4-6 weeks
QuickDASH (Disabilities of the Arm, Shoulder, and Hand)	At enrollment
QuickDASH (Disabilities of the Arm, Shoulder, and Hand)	4-6 weeks
Numerical Rating Scale for Pain	at enrollment
Numerical Rating Scale for Pain	4-6 weeks

Collaborators and Investigators

• Sponsor: Massachusetts General Hospital

Study record dates

Study Major Dates

• Study Start: May 1, 2014
• Primary Completion (Actual): January 1, 2016
• Study Completion (Actual): January 1, 2016

Study Registration Dates

• First Submitted: July 29, 2014
• First Submitted That Met QC Criteria: July 29, 2014
• First Posted (Estimate): July 30, 2014

Study Record Updates

• Last Update Posted (Estimate): December 22, 2016
• Last Update Submitted That Met QC Criteria: December 20, 2016
• Last Verified: December 1, 2016

More Information

Terms related to this study

• Keywords: patients; puzzling; conditions
• Other Study ID Numbers: 2014P000132