Exploring appropriateness criteria for informing the total knee arthroplasty decision-making process: An interpretive...

Area of Science:

• Orthopedic Surgery
• Health Services Research
• Patient Decision-Making

Background:

• The Hawker appropriateness criteria guide total knee arthroplasty (TKA) decisions based on osteoarthritis symptoms, evidence, conservative treatment trials, patient expectations, risk-benefit analysis, and surgical readiness.
• Understanding barriers and facilitators to applying these criteria in clinical practice is crucial for optimizing TKA utilization.

Purpose of the Study:

• To explore the barriers and facilitators encountered when implementing the Hawker appropriateness criteria for TKA in adults with knee osteoarthritis.
• To identify factors influencing the adoption of established TKA appropriateness guidelines in clinical settings.

Main Methods:

• An interpretive descriptive qualitative study was conducted at an academic hospital.
• Semi-structured interviews were performed with 9 healthcare professionals and 14 adult TKA patients.
• Data were analyzed using inductive thematic analysis, mapped to the Consolidated Framework for Implementation Research domains.

Main Results:

• Common barriers included difficulty assessing criteria, patient reliance on clinician decisions, limited access to conservative treatments, implicit subjective assessments, and delayed TKA information.
• Healthcare system factors like lack of timely TKA access and resistance to changing the current TKA process were also identified.
• A single facilitator noted was that evidence and buy-in can drive program changes.

Conclusions:

• Significant barriers exist in clinical practice and the healthcare system that impede the consistent application of TKA appropriateness criteria.
• The limited identified facilitator suggests a need for targeted interventions to address identified barriers.
• Developing tailored interventions is essential to enhance the effective use of the Hawker appropriateness criteria in TKA decision-making and improve patient outcomes.