Evaluating different ways to help patients make informed choices about surgery for knee or hip osteoarthritis
BACKGROUND: Clinical guidelines for the treatment of hip and knee osteoarthritis (OA) emphasize the importance of engaging patients in shared decision-making (SDM) to determine the best treatment for them. Several patient decision aids (PDAs) are available to support SDM for patients who are conside...
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| Format: | eBook |
| Language: | English |
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[Washington, D.C.]
Patient-Centered Outcomes Research Institute (PCORI)
2021, [2021]
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| Series: | Final research report
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| Online Access: | |
| Collection: | National Center for Biotechnology Information - Collection details see MPG.ReNa |
| Summary: | BACKGROUND: Clinical guidelines for the treatment of hip and knee osteoarthritis (OA) emphasize the importance of engaging patients in shared decision-making (SDM) to determine the best treatment for them. Several patient decision aids (PDAs) are available to support SDM for patients who are considering joint-replacement surgery. However, there is limited evidence on the comparative effectiveness of different tools. OBJECTIVE: The purpose was to evaluate the impact of 2 PDAs (a long video PDA vs a short, interactive PDA) and an intervention directed at the surgeon (a summary report that included patients' goals and treatment preferences vs usual care) on their ability to achieve informed, patient-centered (IPC) decisions (defined as the percentage of patients who are well informed and receive their preferred treatment). In addition, we examined whether IPC decisions were associated with better health outcomes and lower surgical rates at follow-up. Linear or logistic regression models were used with the generalized estimating equations approach to account for the clustering of patients within surgeons, as appropriate. No interaction effect was detected between the patient and surgeon interventions; thus, groups were collapsed for analyses. Planned subgroup analyses examined patient-, surgeon-, and intervention-level (eg, usage) factors on outcomes. RESULTS: In total, 1124 patients were eligible for the study and consented to join. We received 967 of 1124 postvisit surveys and 924 of 1119 follow-up surveys (86% and 83% response rate, respectively). On average, the patient sample was aged 65 years (SD, 10 years), female (57%), and White, non-Hispanic (91%), with knee OA (67%). Patients who made an IPC decision had a significantly greater improvement in overall health (mean difference = 0.04 points [95% CI, 0.02-0.07]; P < .001) and knee symptoms (mean diff = 4.9 points [95% CI, 1.5-8.3]; P = .004) than did those who did not make an IPC decision. The IPC decision was not associated with a difference for hip symptoms (mean diff = 1.2 points [95% CI, −3.4 to 5.9]; P = .61). CONCLUSIONS: The DECIDE-OA study is the first randomized comparative effectiveness trial of the long vs short orthopedic PDAs. The 2 PDAs produced similar rates of IPC decisions, and the surgeon intervention was not better than the PDAs alone. The surgeons reported high satisfaction and normal visit length with both PDAs. LIMITATIONS: There were 274 postrandomization exclusions, mostly related to patients not attending the surgeon visit; 14% of participants did not respond to the postvisit survey, and 18% did not respond to the follow-up survey. The majority made IPC decisions (67.4%), and these rates did not vary significantly across PDAs (67.1% long vs 67.3% short; mean difference [diff] = −0.2%; 95% CI, −6.6% to 6.4%) or surgeon groups (67.0% usual care vs 67.3% intervention; mean diff = −0.3%; 95% CI, −6.9% to 6.4%). Knowledge scores were higher for the short PDA (mean = 73.1% long PDA vs 81.9% short PDA; mean diff = 8.8%; 95% CI, 6.0%-11.6%). More than half of the sample (60.1%) had surgery within 6 months of the visit, and rates did not differ significantly by PDA (62.5% long vs 57.6% short; mean diff = 5.0%; 95% CI, −0.4% to 10.4%]) or surgeon (59.7% usual care vs 60.5% intervention; mean diff = −0.8%; 95% CI, −13.7% to 8.0%) groups. Surgeons were highly satisfied and reported that the majority (88.7%) of visits were normal or shorter than normal. METHODS: We used a 2 × 2 factorial randomized trial at 3 sites to randomly assign surgeons to receive the patient preference report or usual care, and then randomly assigned patients to receive the short PDA or long PDA. Patients received the assigned PDA to review at home before their visit with the surgeon and completed 3 surveys: previsit (before their surgeon visit), postvisit (about 1 week after the visit), and follow-up (about 6 months after treatment). Surgeons completed a short survey on 30% of their study patients after the visit. The primary outcome was the proportion of IPC decisions. Key secondary outcomes included knowledge, concordance of patients' preferred treatment and treatment received, and SDM. Patient-reported outcomes included overall quality of life (assessed using the EuroQol-5D), knee symptoms (assessed using the Knee Injury and Osteoarthritis Outcome Score), and hip symptoms (assessed using the Harris Hip Score). Other limitations included the fact that only 73% of participants reported viewing most or all of the PDA content, the surgeon and patient participants were not blinded to their assignments, and racial and ethnic diversity in the patient sample was limited |
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| Physical Description: | 1 PDF file (95 pages) illustrations |