Shared decision-making and patient decision aids in knee osteoarthritis: a scoping review

Shared decision-making is a collaborative approach that enables clinicians and patients to make informed treatment decisions that align with patient preferences. This study examined current practices of shared decision-making in managing knee osteoarthritis.

A comprehensive search was conducted in Cochrane, CINAHL, ProQuest, Scopus, Ovid MEDLINE, and Web of Science databases through August 2025. EndNote 21 was utilized for de-duplication, and Rayyan was used for screening. Studies were analyzed for the use of patient decision aids, shared decision-making outcome measures, and barriers and factors impacting shared decision-making practices.

Of 4708 records screened, 69 studies were included for analysis, comprising 23 randomized controlled trials, 18 qualitative studies, 9 trial protocols, and 19 other observational designs. A total of 44 studies explicitly described the use of a patient decision aid. Reported outcome domains included decision quality, decisional conflict, satisfaction, regret, and patient-clinician communication. Commonly cited barriers to shared decision-making (SDM) implementation were limited clinician time, lack of awareness of patient decision aids (PDAs), and patient difficulty using digital tools.

The included studies suggest that patient decision aids may be a valuable tool for management of knee osteoarthritis, with studies reporting improvements in patient engagement and informed decision-making. However, variability in shared decision-making implementation and inconsistency in outcome measures highlight the need for further research to evaluate the comparative effectiveness of decision aids in clinical practice.