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Patient-centered decision making in the treatment of chronic rhinosinusitis

Authors

  • Zachary M. Soler MD, MSc,

    1. Division of Rhinology and Sinus Surgery, Department of Otolaryngology–Head and Neck Surgery , Medical University of South Carolina, Charleston, South Carolina, U.S.A
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  • Luke Rudmik MD,

    1. Rhinology and Sinus Surgery, Division of Otolaryngology, Department of Surgery , University of Calgary, Calgary, Alberta, Canada
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  • Peter H. Hwang MD,

    1. Department of Otolaryngology–Head and Neck Surgery , Stanford University, Palo Alto, California, U.S.A
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  • Jess C. Mace MPH,

    1. Division of Rhinology and Sinus Surgery , Oregon Sinus Center, Department of Otolaryngology–Head and Neck Surgery, Oregon Health and Science University, Portland, Oregon, U.S.A
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  • Rodney J. Schlosser MD,

    1. Division of Rhinology and Sinus Surgery, Department of Otolaryngology–Head and Neck Surgery , Medical University of South Carolina, Charleston, South Carolina, U.S.A
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  • Timothy L. Smith MD, MPH

    Corresponding author
    • Division of Rhinology and Sinus Surgery , Oregon Sinus Center, Department of Otolaryngology–Head and Neck Surgery, Oregon Health and Science University, Portland, Oregon, U.S.A
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  • This work was submitted for oral presentation at the 116th Annual Meeting of the Triological Society Combined Otolaryngology Spring Meetings, Orlando, Florida, U.S.A., April 10–14, 2013.

  • Zachary M. Soler, MD, MSc, Peter H. Hwang, MD, Jess C. Mace, MPH, and Timothy L. Smith, MD, MPH, are supported by a grant from the National Institute on Deafness and Other Communication Disorders (NIDCD), one of the National Institutes of Health, Bethesda, Maryland (2R01 DC005805; PI: T. L. Smith). Public clinical trial registration (http://www.clinicaltrials.gov) ID#NCT01332136. Timothy L. Smith, MD, is also a consultant for Intersect ENT (Palo Alto, California), which is not affiliated in any way with this investigation.

  • The authors have no other funding, financial relationships, or conflicts of interest to disclose.

Send correspondence to Timothy L. Smith, MD, MPH, Division of Rhinology and Sinus Surgery, Department of Otolaryngology–Head and Neck Surgery, Oregon Health and Science University, 3181 SW Sam Jackson Park Rd., PV-01, Portland, OR 97239. E-mail: smithtim@ohsu.edu

Abstract

Objectives/Hypothesis

To explore possible factors that might impact a patient's choice to pursue endoscopic sinus surgery (ESS) or continue with medical management for treatment of refractory chronic rhinosinusitis (CRS).

Study Design

Cross-sectional evaluation of a multicenter prospective cohort.

Methods

Two hundred forty-two subjects with CRS were prospectively enrolled within four academic tertiary care centers across North America with ongoing symptoms despite prior medical treatment. Subjects either self-selected continued medical management (n = 62) or ESS (n = 180) for treatment of sinonasal symptoms. Differences in demographics, comorbid conditions, and clinical measures of disease severity between subject groups were compared. Validated metrics of social support, personality, risk aversion, and physician–patient relationships were compared using bivariate analyses, predicted probabilities, and receiver operating characteristic curves at the 0.05 alpha level.

Results

No significant differences were found between treatment groups for any demographic characteristic, clinical cofactor, or measure of social support, personality, or the physician–patient relationship. Subjects electing to pursue sinus surgery did report significantly worse average quality-of-life (QOL) scores on the 22-item Sinonasal Outcome Test (SNOT-22; P < .001) compared to those electing continued medical therapy (54.6 ± 18.9 vs. 39.4 ± 17.7), regardless of surgical history or polyp status. SNOT-22 score significantly predicted treatment selection (odds ratio, 1.046; 95% confidence interval, 1.028-1.065; P < .001) and was found to accurately discriminate between subjects choosing endoscopic sinus surgery and those electing medical management 72% of the time.

Conclusions

Worse patient-reported disease severity, as measured by the SNOT-22, was significantly associated with the treatment choice for CRS. Strong consideration should be given for incorporating CRS-specific QOL measures into routine clinical practice.

Level of Evidence

2b. Laryngoscope, 123:2341–2346, 2013

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