The Impact Of Decision Aids On Adults Considering Hip Or Knee Surgery

Abstract

Trials of decision aids developed for use in shared decision making find that patients engaged in that process tend to choose more conservative treatment for preference-sensitive conditions. Shared decision making is a collaborative process in which clinicians and patients discuss tradeoffs and benefits of specific treatment options in light of patient values and preferences. Decision aids are paper, video, or web-based tools intended to help patients match personal preferences with available treatment options. We analyzed data for 2012-15 about patients within the ten High Value Healthcare Collaborative member systems who were exposed to condition-specific decision aids in the context of consultations for hip and knee osteoarthritis, with the intention that the aids be used to support shared decision making. Compared to matched patients not exposed to the decision aids, those exposed had two-and-a-half times the odds of undergoing hip replacement surgery and nearly twice the odds of undergoing knee replacement surgery within six months of

Patient preferences and decision‐making when considering surgery for musculoskeletal disorders: A mixed methods systematic review

“…Three studies indicate mixed association between race and decision‐making. In two, minority (non‐white) patients were significantly less likely to choose surgery (Hurley et al., 2020; Kwoh et al., 2015), another found race was not significantly associated in shoulder and elbow conditions (Modi et al., 2014).…”

“…78 Modi, et al, 2014 Chung et al, 2006;Glassman et al, 2007;Hawker et al, 2004;Nelson et al, 2020;Pizones et al, 2017;Somerson et al, 2018;Trask et al, 2020;Wouters et al, 2019;Yoo et al, 2018;Zeni et al, 2010) (Behairy et al, 2003;G. A. Hawker et al, 2001;Modi et al, 2014) Pain: More (surgical), less (nonsurgical) 6 0 1 (Chung et al, 2006;Glassman et al, 2007;Kwoh et al, 2015;Riffin et al, Perceptions Expectations: Higher (surgical) 5 0 0 (Frankel et al, 2012;Kwoh et al, 2015;Matthies et al, 2020;Modi et al, 2014;Wouters et al, 2019) Psychological/body image/ distress: Higher (surgical) 5 0 0 (Chung et al, 2006;Glassman et al, 2007;Hurley et al, 2020;Pizones et al, 2017;Wouters et al, 2019) Note: Significant finding: studies that reported significant finding in line with the Factor Description. Significant opposing finding: studies that reported significant result favouring the opposing option to the Factor Description.…”

Effectiveness of a decision aid for patients with knee osteoarthritis: a randomized controlled trial

“…Reasons for this lower willingness to undergo TKR include less familiarity with the procedure, or erroneous beliefs about outcomes, duration of hospitalization and recovery 33e35 . The remaining studies included a majority of white participants, with null results in two randomized trials 13,15 , a lower rate of surgery in the PtDA group in one trial 14 and two observational studies 36,37 , and the opposite result in another observational study 38 . Therefore, the current evidence is uncertain.…”

Problem with patient decision aids

“…2 Further, a recent analysis of 5751 patients with hip and knee osteoarthritis found that patients exposed to a patient decision aid were more likely to have joint replacement surgery (hip: OR=2.6; knee: OR=1.8) compared with patients who had not been exposed. 24 Another reason why patient decision aids may not help patients avoid unnecessary care is that they might not technically be 'patient decision aids. ' Many resources are labelled as 'patient decision aids' when, in fact, they do not include the necessary information to certify as a decision aid or support shared decision making.…”