PhD Michiel Hageman

There is substantial variation in rates and types of operative and non-operative treatment that cannot be explained by demographics, pathophysiology or comorbidities alone. The objectives of this thesis were to address several aspects of orthopaedic decision-making from the surgeon and patient perspectives: e.q. how health care providers decide which option to recommend to their patients when the evidence is inconclusive and the effect of decision aids.

The findings of this thesis suggest that if surgeons were more comfortable with discomfort, they might be more likely to acquiesce to patient preferences in areas with no clear best choice. Decision aids might be effective in supporting orthopaedic decision-making from the surgeon and patients perspectives,

Further implementation studies are needed to determine how best to incorporate in care pathways on greater scale to ensure incorporation and implementation of informed patients preferences and to test the influence on practice variance and health outcomes.