Decision aid for patients considering total knee arthroplasty with preference report for surgeons: a pilot randomized controlled trial

Stacey, Dawn; Hawker, Gillian; Dervin, Geoffrey F.; Tugwell, Peter; Boland, Laura; Pomey, Marie‐Pascale; O’Connor, Annette M.; Taljaard, Monica

doi:10.1186/1471-2474-15-54

Cited by 70 publications

(103 citation statements)

References 29 publications

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“…In another study, families reported improvement in knowledge gain, satisfaction, and decisional conflict in children with neuromuscular scoliosis [35]. The use of a decision aid compared with usual education for osteoarthritis patients considering total knee arthroplasty demonstrated that patients exposed to a decision aid had higher decision quality based on knowledge (71 vs. 47%, p < 0.0001), and the decision was more consistent with their values for option outcomes (56.4 vs. 25%, p < 0.001) [36].…”

Section: Introductionmentioning

confidence: 99%

Current concepts of shared decision making in orthopedic surgery

Klifto

Slover

2017

Curr Rev Musculoskelet Med

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Purpose of review The Shared Decision Making (SDM) model, a collaborative decision making process between the physician and patient to make an informed clinical decision that enhances the chance of treatment success as defined by each patient's preferences and values, has become a new and promising tool in the healthcare process; however, minimal data exists on its application in the orthopedic surgical specialty. Increasing evidence has demonstrated that this once novel idea can be implemented successfully in the orthopedic setting to improve patient outcomes. Recent findings SDM can be applied without significant increases in the office length. Patients report that a physician that takes the time to listen to them is among the most important factors in their care. When time was focused on the SDM process, there was a direct correlation between the time spent with a patient and patient satisfaction. Patients exposed to a decision aid prior to surgery gained a greater knowledge from baseline to make a higher quality decision that was consistent with their values. Involving family members preoperatively can help all patients adhere to postoperative regimens. Exposing patients to a decision aid can reduce expensive elective surgeries, in favor of non-operative management. Incorporating patient goals into the decision-making process has increased satisfaction, compliance, and outcomes.Summary SDM is a two-way exchange of information that attempts to correct the inequality of power between the patient and physician. Decision-aids are helpful tools that facilitate the decision-making process. Treatment decisions are consistent with patient preferences and values when there may be no "best" therapy. A good patient-physician relationship is essential during the process to reduce decisional conflict and increase overall patient outcomes.

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Section: Introductionmentioning

confidence: 99%

Current concepts of shared decision making in orthopedic surgery

Klifto

Slover

2017

Curr Rev Musculoskelet Med

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“…Physicians help educate the patient, and patients relate preferences based on their own values. Incorporating patient preferences can lead to better patient satisfaction, improved decision quality, appropriate utilization of health-care resources by an informed patient, and better outcomes, thereby increasing value for patients [13][14][15] .…”

Section: Value-based Advancements In the United Statesmentioning

confidence: 99%

Improving Value in Musculoskeletal Care Delivery

Wei

Hawker

Jevsevar

et al. 2015

The Journal of Bone and Joint Surgery-American Volume

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Improving value in musculoskeletal health care has emerged as an important objective in both the United States and Canada. In order to achieve this objective, providers need to have a clear definition of value and an infrastructure for measuring outcomes of interest to patients and costs over the episode of care. Although national patient registries have been established in the United States and Canada, they nevertheless lag behind other registries worldwide in terms of collecting patient-reported outcomes and capturing data from a wide cross-section of hospitals and physicians. With the help of professional medical societies and the creation of national initiatives, patient-reported outcomes data collection on a large scale may be possible, but many challenges remain regarding implementation. Alternatives to the fee-for-service payment model, including pay-for-reporting and pay-for-performance, may help incentivize physicians and health-care providers to obtain and improve on patient-reported outcomes data collection. Other payment reforms, such as bundled payments, have been piloted in certain regions, but their sustainability and long-term success are unclear at this time. Novel health-care delivery strategies aimed at improving quality, coordinating multispecialty care, and enhancing patient participation in shared decision-making have shown promise in improving patient-centered outcomes, but delivery models continue to vary greatly throughout the United States and Canada. The current status of musculoskeletal health-care delivery requires substantial change before the goal of improving patient outcomes and lowering health-care costs can be achieved.

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“…These findings, combined with the patients' clinical data, were summarized in a 1-page report and sent to the surgeon. 5,8 All patients (control and intervention) received clinicspecific written information about the prerehabilitation …”

Section: Interventionmentioning

confidence: 99%

“…[5][6][7] In Canada and the United States, randomized controlled trials (RCTs) evaluating decision aids for patients considering TKA showed that patients who used decision aids were more knowledgeable, had more realistic expectations, achieved better decision quality (i.e., extent that informed decisions were consistent with patient preferences), were more prepared for the surgical consultation, and had reduced decisional conflict (i.e., uncertainty about the best treatment option). [7][8][9] Orthopedic surgeons also reported improved satisfaction and consultation efficiency when their patients were exposed to a decision aid. 9 A Canadian trial showed that decision aids resulted in lower costs and more quality-adjusted life years for patients considering total joint arthroplasty.…”

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confidence: 99%

Effect of patient decision aid was influenced by presurgical evaluation among patients with osteoarthritis of the knee

Boland

Taljaard

Dervin

et al. 2018

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RESEARCH • RECHERCHEEffect of patient decision aid was influenced by presurgical evaluation among patients with osteoarthritis of the knee Background: Decision aids help patients make total joint arthroplasty decisions, but presurgical evaluation might influence the effects of a decision aid. We compared the effects of a decision aid among patients considering total knee arthroplasty at 2 surgical screening clinics with different evaluation processes. Methods:We performed a subgroup analysis of a randomized controlled trial. Patients were recruited from 2 surgical screening clinics: an academic clinic providing 20-minute physician consultations and a community clinic providing 45-minute physiotherapist/nurse consultations with education. We compared the effects of decision quality, decisional conflict and surgery rate using Cochran-MantelHaenszel χ 2 tests and the Breslow-Day test. Results:We evaluated 242 patients: 123 from the academic clinic (61 who used the decision aid and 62 controls) and 119 from the community clinic (59 who used the decision aid and 60 controls). Results suggested a between-site difference in the effect of the decision aid on the patients' decision quality (p = 0.09): at the academic site, patients who used the decision aid were more likely to make better-quality decisions than controls (54% v. 35%, p = 0.044), but not at the community site (47% v. 51%, p = 0.71). Fewer patients who used decision aids at the academic site than at the community site experienced decisional conflict (p = 0.007) (33% v. 52%, p = 0.05 at the academic site and 40% v. 24%, p = 0.08 at the community site). The effect of the decision aid on surgery rates did not differ between sites (p = 0.65). Conclusion:The decision aid had a greater effect at the academic site than at the community site, which provided longer consultations with more verbal education. Hence, decision aids might be of greater value when more extensive total knee arthroplasty presurgical assessment and counselling are either impractical or unavailable.Contexte : Les aides à la décision guident les patients dans leurs choix quant à l'arthroplastie par prothèse totale, mais l'évaluation préopératoire pourrait modifier leur influence. Nous avons comparé cette influence chez les patients qui envisagent une arthroplastie totale du genou dans 2 cliniques de dépistage chirurgical ayant des processus d'évaluation différents. Méthodes

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Decision aid for patients considering total knee arthroplasty with preference report for surgeons: a pilot randomized controlled trial

Cited by 70 publications

References 29 publications

Current concepts of shared decision making in orthopedic surgery

Current concepts of shared decision making in orthopedic surgery

Improving Value in Musculoskeletal Care Delivery

Effect of patient decision aid was influenced by presurgical evaluation among patients with osteoarthritis of the knee

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