Impact of 3D Printed Models on Shared Decision Making: A Cluster Randomized Controlled Trial

Importance: Surgical patients report a lack of involvement in healthcare decisions and increased anxiety. 3D models serve as educational tools to encourage patient engagement, reduce anxiety levels, and aid understanding. We hypothesized that patients who receive pre-operative education with by 3D-printed anatomic models would perceive a higher involvement in decision making and experience lower anxiety levels versus "standard care." Objective: To determine the impact of 3D-printed models on shared decision making and patient anxiety during the pre-operative surgical consultation. Design: Single-center cluster randomized control trial. Setting: Colorectal surgery clinic at a tertiary hospital. Participants: Adult (18 years or older) patients scheduled for partial or complete colon and/or rectal resection. Intervention/s: Surgeons were cluster-randomized to counsel patients using a modular 3D-printed model or providing standard care during pre-operative clinic visits. Main outcomes: The primary outcome was the patient's perception of involvement in decision making, assessed using the validated Shared Decision Making Questionnaire (SDM-Q9). The secondary outcome was the change in anxiety level measured using the validated State-Trait Anxiety Inventory (STAI-6). Results: A total of 51 patients, 28 in the 3D-printed arm and 23 in the standard care arm, met the inclusion criteria and agreed to participate. The mean age of participants was 51.1 years, with 55% female. Patients counseled with the 3D-printed model reported significantly higher involvement in shared decision making (mean score of 93.9 [SD 8.8] vs. 82.9 [SD 12.1], p <0.001), which was also clinically significant. Additionally, using a 3D-printed model significantly reduced anxiety scores (47.3 [6.0] to 46.4 [5.6]) compared to patients taught using conventional methods (48.3 [7.4] to 51.1 [9.7], p <0.008), but this effect was not deemed clinically significant. Conclusions: The use of 3D models at pre-operative clinic visits improves shared decision making among patients planning to undergo colorectal surgery. Relevance: This study highlights the potential of using 3D-printed models as an effective tool for a more collaborative and informed patient-clinician interaction. Given the positive findings, we recommend broadly implementing this technology.