Shared Decision‐Making Applied to Knee Arthroplasty: A Systematic Review of Randomized Trials

Abstract

Objective Shared decision‐making (SDM) is a strongly endorsed approach by which patients and clinicians work together to formulate a sensible care plan. The present study was undertaken to conduct a systematic review of SDM trials in patients considering knee arthroplasty (KA) to characterize how SDM was supported and the impact on care received. Methods We searched multiple bibliographic databases from inception to December 31, 2019. A pair of reviewers working independently selected studies for inclusion, extracted data, and evaluated each trial’s risk of bias. Results We found 6 eligible randomized trials (4 included KA and hip arthroplasty), all of which tested the same proprietary decision aid (DA) (Treatment Choices for Hip or Knee Osteoarthritis), with some adding other materials to support SDM. These trials, all of which had moderate‐to‐high risk of bias, focused on assessing the effect of the DA on patient knowledge about the options while not explicitly supporting other aspects of SDM, such as choice awareness, deliberation, or decision‐making. One trial found an increase in the number of African American patients undergoing KA in the 12 months following the intervention. No other trials found that SDM impacts clinical outcomes. Conclusion Evidence for SDM in patients considering KA is mostly limited to a single DA. While use of this DA improves patient knowledge about their treatment options, this tool has not been shown to promote SDM, impact treatment decisions, or satisfaction with care. Future work should seek to support SDM directly and assess effects on treatment decisions, functional outcomes, and satisfaction.

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

“…Positive effects of DAs related to decisional conflict and knowledge are reflected in previous studies[ 7 , 8 ]. Achaval et al [ 7 ] investigated the effect of an education booklet, video booklet and decision tool on the decisional conflict among patients with knee OA.…”

“…It showed a significant overall reduction in decisional conflict. A recent systematic review by Riddle et al [ 8 ] looked primarily at the effect of DAs on patients’ knowledge considering total knee arthroplasty. They found a positive effect on the knowledge of patients, but no effect on patients’ anxiety, satisfaction or decisional conflict.…”

An online individualised patient decision aid improves the quality of decisions in patients considering total knee arthroplasty in routine care: A randomized controlled trial

“…Shared decision making (SDM) has been widely advocated as a way to better set these expectations [ 9 ], by informing patients about the benefits and harms of TKA and non-surgical conservative management options which are effective [ 10 ], but underutilized [ 11 ]. Previous studies have found that using a patient decision aid to promote SDM can improve knowledge and the quality of decisions [ 12 ], overcoming common biases where individuals often overestimated an intervention's benefit and underestimated its harms [ 13 ]. However, these studies have typically not been conducted in routine care and so the results are potentially less generalizable [ 12 ].…”

Protocol for systematic review: patient decision aids for total hip and knee arthroplasty decision-making

“…To our knowledge, no systematic review has been conducted on PtDAs for adults with OA considering primary elective THA and TKA decision-making. This review will complement the systematic review of Riddle et al [53] by focusing on PtDAs by (1) providing a summary of RCTs findings on PtDAs effect on decision-making quality and process of adults with knee and hip OA considering primary elective TJA and by (2) providing evidence comparing different types of PtDA used for hip and knee TJA decisionmaking.…”

“…A recent systematic review exploring features and impact of SDM/PtDA interventions for knee arthritis TJA decision-making found that most trials did not include all key aspects of SDM [53]. The authors recognized the need for future research to focus on assessing the effect of PtDAs and SDM on treatment decision, functional outcomes, and satisfaction [53].…”