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Does a Patient-centered Educational Intervention Affect African-American Access to Knee Replacement? A Randomized
Ernest R Vina1, Diane Richardson2, Elina Medvedeva2
1University of Arizona School of Medicine and University of Arizona Arthritis Center, 1501 N. Campbell Avenue, Tucson, AZ, 85724, USA. evina@email.arizona.edu.
Clinical Orthopaedics and Related Research
|April 15, 2016
Summary
A patient-centered intervention did not improve referrals or willingness for total knee arthroplasty (TKA) in Black patients with knee osteoarthritis. Further research is needed to develop effective tools for surgical treatment decisions.
Area of Science:
- Orthopaedic Surgery
- Public Health
- Patient Decision Making
Background:
- Total knee arthroplasty (TKA) is effective for knee osteoarthritis (OA), but Black patients show lower willingness for surgery compared to White patients.
- Decision aids and motivational interviewing aim to improve patient understanding and consideration of treatment options like TKA.
Purpose of the Study:
- To evaluate if a patient-centered intervention (decision aid + motivational interviewing) increases orthopaedic surgery referrals for Black patients with knee OA.
- To determine if the intervention enhances patients' willingness to undergo TKA.
Main Methods:
- A randomized controlled trial enrolled 493 Black patients (≥50 years) with moderate to severe knee OA.
- The intervention group received a decision-aid video and motivational interviewing; the control group received an OA educational booklet.
- Primary outcome was referral to orthopaedic surgery at 12 months; secondary outcome was change in willingness to undergo TKA.
Main Results:
- No significant difference in orthopaedic surgery referrals between the intervention and control groups (OR, 0.81; p=0.277).
- Willingness to consider TKA did not differ at 2 weeks (OR, 1.06; p=0.779) or 12 months (OR, 1.10; p=0.679) follow-up.
Conclusions:
- The combined decision aid and motivational interviewing strategy was not superior to an educational pamphlet for improving knee OA patients' preferences for TKA.
- The intervention did not improve access to surgical evaluation, suggesting a need for novel tools to address patient knowledge and attitudes towards surgical treatments.
