Patient, surgeon, and healthcare purchaser views on the use of decision and communication aids in orthopaedic surgery: a mixed methods study

Abstract

BackgroundDespite evidence that decision and communication aids are effective for enhancing the quality of preference-sensitive decisions, their adoption in the field of orthopaedic surgery has been limited. The purpose of this mixed-methods study was to evaluate the perceived value of decision and communication aids among different healthcare stakeholders.MethodsPatients with hip or knee arthritis, orthopaedic surgeons who perform hip and knee replacement procedures, and a group of large, self-insured employers (healthcare purchasers) were surveyed regarding their views on the value of decision and communication aids in orthopaedics. Patients with hip or knee arthritis who participated in a randomized controlled trial involving decision and communication aids were asked to complete an online survey about what was most and least beneficial about each of the tools they used, the ideal mode of administration of these tools and services, and their interest in receiving comparable materials and services in the future. A subset of these patients were invited to participate in a telephone interview, where there were asked to rank and attribute a monetary value to the interventions. These interviews were analyzed using a qualitative and mixed methods analysis software. Members of the American Hip and Knee Surgeons (AAHKS) were surveyed on their perceptions and usage of decision and communication aids in orthopaedic practice. Healthcare purchasers were interviewed about their perspectives on patient-oriented decision support.ResultsAll stakeholders saw value in decision and communication aids, with the major barrier to implementation being cost. Both patients and surgeons would be willing to bear at least part of the cost of implementing these tools, while employers felt health plans should be responsible for shouldering the costs.ConclusionsDecision and communication aids can be effective tools for incorporating patients preferences and values into preference-sensitive decisions in orthopaedics. Future efforts should be aimed at assessing strategies for efficient implementation of these tools into widespread orthopaedic practice.Electronic supplementary materialThe online version of this article (doi:10.1186/1472-6963-14-366) contains supplementary material, which is available to authorized users.

Should consultation recording use be a practice standard? A systematic review of the effectiveness and implementation of consultation recordings

“…The patients had an overall positive perspective of consultation recordings. Sixteen studies (7 RCTs and 9 CS) reported that most participants found recordings useful or beneficial, with a range of 55 to 98% across studies . However, listening to the recording was distressing (3‐18%) or a source of anxiety (19‐26.8%) for small proportions of participants.…”

“…There were reservations about the amount of time that recordings might require in an already overloaded clinical setting . However, researchers reported that recordings did not substantially increase the length of consultations, and some even found it was an efficient means of promoting the doctor‐patient partnership .…”

“…This study design is especially vulnerable to the impact of confounding variables and alternative explanations for the results . Second, there were a number of studies in which consultation recording was part of a complex intervention that included other decision or communication aids . In a complex intervention, it may not be possible to attribute findings to a particular component of an intervention such as the recording.…”

“…4,20,21 The remaining 7 studies occurred outside of the oncology context. 4,10,[33][34][35][36][37] The geographical settings included the United Kingdom, 2,4,10,26,[28][29][30]33,34 United States, 1,19,24,32,36 Canada, 9,21,27,31 Australia, 3,22,23,37 Sweden, 20 the Netherlands, 8 Italy, 25 and Denmark. 35 Table S2 summarizes the RCT and QE quality appraisals.…”

“…These qualitative studies were identified when screening titles/abstracts for objective 1 or found in the 92 articles retrieved in the systematic search for objective 2. The studies explored patients' experiences/perspectives of consultation recording 26,31,34,36,[38][39][40][41][42] and health-care professionals' experiences of consultation recording implementation. 12,31,34,36,40,43,44 The qualitative studies took place in the United States, 36,38,40,43,44 UK, 26,34,39,41,42 Canada, 31 and Australia.…”