Does a Patient-centered Educational Intervention Affect African-American Access to Knee Replacement? A Randomized Trial

Abstract

Background A TKA is the most effective and cost-effective surgical option for moderate to severe osteoarthritis (OA) of the knee. Yet, black patients are less willing to undergo knee replacement surgery than white patients. Decision aids help people understand treatment options and consider the personal importance of possible benefits and harms of treatments, including TKA. Questions/purposes We asked: (1) Does a patient-centered intervention consisting of a decision aid for knee OA and motivational interviewing improve the proportion of referrals of blacks with knee OA to orthopaedic surgery? (2) Does the intervention increase patients' willingness to undergo TKA? Methods Adults who self-identified as black who were at least 50 years old with moderate to severe knee OA were enrolled from urban primary care clinics in a two-group randomized, controlled trial. A total of 1253 patients were screened for eligibility, and 760 were excluded for not meeting inclusion criteria, declining to participate, or other reasons. Four hundred ninety-three patients were randomized and completed the intervention; three had missing referral data at followup. The mean age of the patients was 61 years, and 51% were women. The majority had an annual household income less than USD 15,000. Participants in the treatment group were shown a decision-aid video and had a brief session with a trained counselor in motivational interviewing.

The effectiveness of a web-based decision aid for patients with hip osteoarthritis: study protocol for a randomized controlled trial.

“…Among them, PtDAs have the strongest evidence favoring their e cacy in increasing patients' knowledge, decreasing their decisional con ict, and in general improving the decision-making process and the quality of their health care decisions (understood as being informed and concordant with own values/preferences) [13,28]. In the eld of OA, however, the number of available PtDAs is very scarce, and published RCTs are limited and their assessed outcomes heterogeneous [13,26,29,30]. Furthermore, they have included only patients with knee OA or have not reported separated data for hip patients [15,16,31].…”

The effectiveness of a web-based decision aid for patients with hip osteoarthritis: study protocol for a randomized controlled trial

“…Among them, PtDAs have the strongest evidence favoring their efficacy in increasing patients’ knowledge, decreasing their decisional conflict, and in general improving the decision-making process and the quality of their health care decisions (understood as being informed and concordant with own values/preferences) [ 13 , 28 ]. In the field of OA, however, the number of available PtDAs is very scarce, and published RCTs are limited and their assessed outcomes heterogeneous [ 13 , 26 , 29 , 30 ]. Furthermore, they have included only patients with knee OA or have not reported separated data for hip patients [ 15 , 16 , 31 ].…”

Protocol for a systematic review of randomized trials of knee arthroplasty decision aids and shared decision-making approaches

“…This review will provide a comprehensive summary of the clinical trial evidence related to the use of DA/SDM approaches as applied to patients undergoing TKA, the most common major surgical procedure conducted in the USA. To date, several DA/SDM clinical trials are known to have been published [14, 22, 25–28], and it is likely that the comprehensive search planned as part of the systematic review will identify other trials. The findings from this systematic review will inform future research of DA/SDM approaches for patients with TKA at a time when substantial emphasis is being placed on SDM approaches for beneficiaries by third-party payers such as the Centers for Medicare and Medicaid Services [4].…”