Decision Support Strategies for Hip and Knee Osteoarthritis: Less Is More: A Randomized Comparative Effectiveness
Karen Sepucha1,2, Hany Bedair1,2,3, Liyang Yu1
1Massachusetts General Hospital, Boston, Massachusetts.
The Journal of Bone and Joint Surgery. American Volume
|October 1, 2019
Summary
A short, interactive patient decision aid (DA) improved patient knowledge more than a long DA for osteoarthritis surgery decisions. Both DAs supported informed decisions and surgeon satisfaction.
Area of Science:
- Orthopaedic surgery
- Patient decision-making
- Health services research
Background:
- Patient decision aids (DAs) are increasingly recommended for elective orthopaedic surgery.
- Evidence on the comparative effectiveness of different DAs is crucial for implementation.
- This study evaluated two DAs for hip and knee osteoarthritis.
Purpose of the Study:
- To compare the effectiveness of a short, interactive DA versus a long, detailed DA.
- To assess impact on informed patient-centered decisions, shared decision-making, and surgical rates.
- To evaluate surgeon satisfaction and visit duration.
Main Methods:
- Multisite factorial randomized trial involving patients with hip or knee osteoarthritis.
- Patients randomly assigned to use a short or long DA.
- Surgeons randomly assigned to receive patient preference reports or usual care.
Main Results:
- No significant difference in informed patient-centered decisions between DA groups (p = 0.97).
- The short DA group showed significantly higher knowledge scores (mean difference = 9%; p < 0.001).
- Surgical rates and surgeon satisfaction were comparable between groups; visits remained normal duration.
Conclusions:
- The short, interactive DA demonstrated superior effectiveness in enhancing patient knowledge compared to the long DA.
- Both DAs facilitated informed decisions and were associated with high surgeon satisfaction.
- Decision aids can support shared decision-making and informed consent for joint replacement surgery.
