Partial or total knee replacement? Identifying patients’ information needs on knee replacement surgery: a qualitative study to inform a decision aid

Abstract

Purpose For patients with end-stage knee osteoarthritis, joint replacement is a widely used and successful operation to help improve quality-of-life when non-operative measures have failed. For a significant proportion of patients there is a choice between a partial or total knee replacement. Decision aids can help people weigh up the need for and benefits of treatment against possible risks and side-effects. This study explored patients' experiences of deciding to undergo knee replacement surgery to identify information priorities, to inform a knee replacement decision aid. Methods Four focus groups were held with 31 patients who were candidates for both partial and total knee replacement surgery. Two focus groups included patients with no prior knee replacement surgery (pre-surgery); two with patients with one knee already replaced and who were candidates for a second surgery on their other knee (post-surgery). Data were analysed using Framework Analysis. Results Participants described a process of arriving at 'readiness for surgery' a turning point where the need for treatment outweighed their concerns. Referral and personal factors influenced their decision-making and expectations of surgery in the hope to return to a former self. Those with previous knee surgery offered insights into whether their expectations were met. 'Information for decisions' details the practicality and the optimal timing for the delivery of a knee replacement decision aid. In particular, participants would have valued hearing about the experiences of other patients and seeing detailed pictures of both surgical options. Information priorities were identified to include in a decision aid for knee replacement surgery. Conclusions Patients' experiences of surgical decision-making have much in common with the Necessity-Concerns Framework. Whilst originally developed to understand drug treatment decisions and adherence, it provides a useful lens to understand decision-making about surgery. The use of a decision aid could enhance decision-making on knee replacement surgery. Ultimately, patients' understanding of the risks and benefits of both surgical options could be improved and in turn, help informed decision-making. The knee replacement decision aid is perceived as a useful tool to be associated with other detailed information resources as recommended.

Comparison of an Artificial Intelligence–Enabled Patient Decision Aid vs Educational Material on Decision Quality, Shared Decision-Making, Patient Experience, and Functional Outcomes in Adults With Knee Osteoarthritis

“…Patients using the tool may feel more involved, informed, and in control of the decision-making process; this warrants further study. 56 , 57 …”

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

“…ArthritisPower is an affiliated patient-powered research network (PPRN), open to all members of CreakyJoints. ArthritisPower allows participants to track their own clinical data over time and enroll in research studies [31,32]. Members of ArthritisPower were recruited to participate in focus groups related to joint replacement.…”

Developing a novel psychographic-behavioral qualitative mapping method for exergames

“…Data was sifted, charted, and sorted that addressed key domains of the framework. Finally, the findings from the qualitative mapping method were visually displayed [52,53] by juxtaposing psychographic factors and behavioral descriptors.…”

“…The final step was to visually represent a simplified account [52,53] of player preference and behavior, supported by the use of NVivo 12 Plus (QSR International) [50]. This is demonstrated through the qualitative psychographic-behavioral summary of results The different themes and related sub-themes are further explored in detail below.…”

“…The qualitative mapping method can therefore be used to show patterns across different factors shown in the psychographicbehavioral mapping method. For our qualitative mapping method, it is not about the number of times something is mentioned, it is about hermeneutics and patterns of themes that Table6displays[52][53][54]. A psychographic-behavioral qualitative mapping method of current players and former players and the interaction across constraints and enablers…”