Decision aids can decrease decisional conflict in patients with hip or knee osteoarthritis: Randomized controlled trial

Abstract

BACKGROUND The interest in shared decision making has increased considerably over the last couple of decades. Decision aids (DAs) can help in shared decision making. Especially when there is more than one reasonable option and outcomes between treatments are comparable. AIM To investigate if the use of DAs decreases decisional conflict in patients when choosing treatment for knee or hip osteoarthritis (OA). METHODS In this multi-center unblinded randomized controlled trial of patients with knee or hip OA were included from four secondary and tertiary referral centers. One-hundred-thirty-one patients who consulted an orthopedic surgeon for the first time with knee or hip OA were included between December 2014 and January 2016. After the first consultation, patients were randomly assigned by a computer to the control group which was treated according to standard care, or to the intervention group which was treated with standard care and provided with a DA. After the first consultation, patients were asked to complete questionnaires about decisional conflict (DCS), satisfaction, anxiety (PASS-20), gained knowledge, stage of decision making and preferred treatment. Follow-up was carried out after 26 wk and evaluated decisional conflict, satisfaction, anxiety, health outcomes (HOOS/KOOS), quality of life (EQ5D) and chosen treatment. RESULTS After the first consultation, patients in the intervention group (mean DCS: 25 out of 100, SD: 13) had significantly ( P value: 0.00) less decisional conflict compared to patients in the control group (mean DCS: 39 out of 100, SD 11). The mean satisfaction score for the given information (7.6 out of 10, SD: 1.8 vs 8.6 out of 10, SD: 1.1) ( P value: 0.00), mean satisfaction score with the physician (8.3 out of 10, SD: 1.7 vs 8.9 out of 10, SD: 0.9) ( P value: 0.01) and the mean knowledge score (3.3 out of 4, SD: 0.9 vs 3.7 out of, SD: 0.6) ( P value: 0.01) were all significantly higher in the intervention group. At 26-wk follow-up, only 75 of 131 patients (57%) were available for analysis. This sample is too small for meaningful analysis. CONCLUSION Providing patients with an additional DA may have a positive effect on decisional conflict after the first consultation. Due to loss to follow-up we are unsure if this effect remains over time.

CORR Insights®: General Anxiety Is Associated With Problematic Initial Recovery After Carpal Tunnel Release

“…To provide full biopsychosocial care to patients with musculoskeletal concerns, orthopaedic surgeons should incorporate shared clinical decision-making discussions and expectation-setting into routine clinic encounters. Decision aids, which can be used to support shared clinical decision-making, have been shown to diminish decisional conflict [10]. Decision aids may also decrease patient anxiety around their musculoskeletal health because patients are actively involved in their own care.…”

Video‐Based Decision Aids Improve Sleep Surgery Decision‐Making: A Randomized Controlled Trial

“…Informational decision aids have been successfully employed across medical specialties to decrease DC and improve shared decision-making for patients considering surgery versus medical management. [7][8][9] However, the application of these tools for OSA treatment has thus far been limited to non-surgical management or pediatric OSA. [10][11][12][13][14] We developed a series of video-based decision aids with the goal of improving patient decisional readiness and decision quality when considering whether to pursue surgical alternatives to PAP.…”

“…Informational decision aids have been successfully employed across medical specialties to decrease DC and improve shared decision‐making for patients considering surgery versus medical management 7–9 . However, the application of these tools for OSA treatment has thus far been limited to non‐surgical management or pediatric OSA 10–14 .…”

OMERACT Core outcome measurement set for shared decision making in rheumatic and musculoskeletal conditions: a scoping review to identify candidate instruments

“…•Hip OA (n=3) 34,46,118 •Trapeziometacarpal arthritis (n=1) 121 •Lumbar herniated disc (n=1) 26 •Lumbar degenerative diseases (n=1) 41 •Spinal stenosis (n=1) 70 •Rheumatoid arthritis (n=7) 50,51,53,79,87,89,94 •Osteopenia or osteoporosis (n=5) 42,78,90,93,111 •Fibromyalgia (n=2) 30,58 •Carpal tunnel syndrome (n=1) 55 •Anterior shoulder dislocation (n=1) Validity:…”

“…•Validated: -no information in which populations 41,46,118 •Discriminant validity: -no information in which populations 42,87,119,120,123 Reliability:…”