Identifying patient decisions and related information needs during decision making related to total knee arthroplasty

Abstract

Aim: Research regarding decisions patients make about total knee arthroplasty, apart from having the procedure or not, are limited. Understanding patient decision making and related information needs is essential for shared decision making. Methods: Focus groups with an online community-based sample identified decisions about total knee arthroplasty beyond the decision to have the surgery itself. An online survey was used to determine relative importance of five major decisions and evaluate related information available. Results: Patients did not feel they have enough information to make important decisions of surgeon, device type, surgical approach, facility, or timing, for their total knee arthroplasty. Conclusion: Although further research is needed to generalize these findings, physicians should consider these questions during shared decision making with patients considering total knee arthroplasty.

Exploring appropriateness criteria for informing the total knee arthroplasty decision‐making process: An interpretive descriptive study

“…In our study, adults with TKA reported limited knowledge about OA alternative treatment options, the TKA processes (e.g., recovery and rehabilitation) and postoperative expectations, but many adults revealed wanting to participate in the TKA decision. This is consistent with other studies reporting the desire of adults with OA to receive more information about OA, available treatment options, TKA processes (e.g., perioperative processes, recovery and rehabilitation) and implications and participate in decision‐making 7,36 . To support active patient involvement in decision‐making, patients need education on alternative treatment options early in the OA disease process to support time management 13 .…”

“…This is consistent with other studies reporting the desire of adults with OA to receive more information about OA, available treatment options, TKA processes (e.g., perioperative processes, recovery and rehabilitation) and implications and participate in decision-making. 7,36 To support active patient involvement in decision-making, patients need education on alternative treatment options early in the OA disease process to support time management. 13 However, in the current TKA pathway, patients considering TKA were given educational materials on TKA, or other alternative treatments when deemed not eligible for surgery, after the decision to refer to an orthopaedic surgeon is made.…”

“…Hence, TKA is considered a ‘preference‐sensitive’ decision given it is one of several treatment options (e.g., physiotherapy, weight loss, pain medication and surgery) with different benefits and harms 5,6 . Yet, many patients who received a TKA reported poor consideration of their preferences and values when making the decision to undergo TKA 7 . Specifically, they report receiving little information on TKA procedures, potential outcomes, alternative treatment options and benefits and risks leading to poor decision quality, unrealistic expectations, and dissatisfaction with surgery results 8–10 …”

“…5,6 Yet, many patients who received a TKA reported poor consideration of their preferences and values when making the decision to undergo TKA. 7 Specifically, they report receiving little information on TKA procedures, potential outcomes, alternative treatment options and benefits and risks leading to poor decision quality, unrealistic expectations, and dissatisfaction with surgery results. [8][9][10] To address these challenges, Hawker et al together with OA experts (surgeons, rheumatologists and health services researchers)…”

Patients’ perspectives on the benefits of feedback on patient-reported outcome measures in a web-based personalized decision report for hip and knee osteoarthritis

“…Our third finding of building confidence and trust highlights patients’ perceptions of the importance of decreasing fear or anxiety in the decision-making process. In previous research, patients expressed concerns and information needs related to postoperative function and quality of life and trust of physician [ 48 – 50 ]. As identified by our participants, a PROM-based report may help alleviate these concerns.…”