Professional Abstract

Objective

To evaluate the effectiveness of two patient decision aids for knee or hip osteoarthritis and surgeon receipt of a patient preference report on improving informed surgical decisions

Study Design

Design Elements	Description
Design	Randomized controlled trial
Population	1,124 patients ages 21 and older visiting an orthopedic surgeon for diagnosed knee or hip osteoarthritis
Interventions/ Comparators	Shorter, interactive patient decision aid and no patient preference report shared with surgeon Shorter, interactive patient decision aid with patient preference report shared with surgeon Longer, video-based patient decision aid and no patient preference report shared with surgeon Longer, video-based patient decision aid with patient preference report shared with surgeon
Outcomes	Primary: rate of informed patient-centered decisions assessed through the Hip/Knee Osteoarthritis Decision Quality Instrument Secondary: knowledge about knee osteoarthritis treatment options, concordance rate between patient preferences and patient decision, level of shared decision making, surgical rates
Timeframe	1-week follow-up for primary outcome

This randomized controlled trial with a 2x2 factorial design compared the effectiveness of two patient decision aids for knee or hip osteoarthritis and sharing versus not sharing a patient preference report with surgeons on improving informed surgical decisions.

Researchers randomly assigned patients to receive one of two patient decision aids designed to help patients decide between surgical and non-surgical options to treat their knee or hip osteoarthritis. One intervention was a long, video-based decision aid that included a 45-minute DVD and 40-page booklet. The same information was available on the internet. The other was a short, interactive decision aid available on the internet or as a 17-page pamphlet. Researchers also randomly assigned patients’ surgeons to receive a one-page patient preference report or no report. The report included patient responses about their goal for the visit, the impact of their condition on daily life, and treatment preference.

Patients took three surveys on outcomes—before the visit, one week after the visit, and six months after the visit or six months after surgery if patients chose surgery. Researchers compared outcomes between the decision aid groups and then between surgeon patient preference report groups.

The study included 1,124 patients ages 21 and older who were considering surgery for knee or hip osteoarthritis. Of these patients, 91% were white and non-Hispanic and 11% were other races or ethnicities. The average age was 65, and 57% were female.

Patients who had experience with knee or hip osteoarthritis, nurses, primary care doctors, surgeons, and staff from health plans and health systems provided input on the study design, recruitment, data collection, and analysis.

Results

Shortly after the visit with the surgeon, the rate of informed decisions did not differ significantly between decision aid or patient preference report groups. Across groups, most participants reported having made informed decisions (67.4% overall).

Patients who received the shorter decision aid had significantly more knowledge about treatment options than patients who received the longer decision aid (p<0.001). The two decision aid groups and two patient preference report groups did not differ significantly in the number of patients whose treatment matched their preferences or the rate of patients who had surgery.

Limitations

Surgeons reported low use of the patient preference report, which may have contributed to the observed lack of differences. Most participants were white and non-Hispanic. Results may differ for patients of other races and ethnicities.

Conclusions and Relevance

In this study, the two decision aids showed similar rates of effectiveness in supporting informed patient-centered decisions. Sharing the patient preference report with surgeons did not significantly improve outcomes compared with the decision aids alone.

Future Research Needs

Future research could continue to examine how surgeons can effectively incorporate patient goals and treatment preferences into decision making.