Decision aid for patients considering total knee arthroplasty with preference report for surgeons: a pilot randomized controlled trial

BMC Musculoskeletal Disorders

Monica Taljaard¹  Annette M O’Connor³  Marie-Pascale Pomey⁴  Laura Boland³  Peter Tugwell³  Geoffrey Dervin³  Gillian Hawker²  Dawn Stacey³ 

[1] Ottawa Hospital Research Institute, 501 Smyth Road, Ottawa, ON K1H 8L6, Canada;University of Toronto and Women’s College Hospital, 76 Grenville Street, Toronto, ON M5S 1B2, Canada;Patient Decision Aid Research Group, Ottawa Hospital Research Institute, 501 Smyth Road, Ottawa, ON K1H 8L6, Canada;University of Montréal, 7101 Parc Avenue, Montreal, QC H3N 1X7, Canada

关键词: Decision quality;    Wait times;    Joint arthroplasty;    Osteoarthritis;    Patient preferences;    Patient decision aids;   

Others  :  1128755
DOI  :  10.1186/1471-2474-15-54

 received in 2013-11-11, accepted in 2014-02-18,  发布年份 2014

【 摘 要 】

Background

To evaluate feasibility and potential effectiveness of a patient decision aid (PtDA) for patients and a preference report for surgeons to reduce wait times and improve decision quality in patients with osteoarthritis considering total knee replacement.

Methods

A prospective two-arm pilot randomized controlled trial. Patients with osteoarthritis were eligible if they understood English and were referred for surgical consultation about an initial total knee arthroplasty at a Canadian orthopaedic joint assessment clinic. Patients were randomized to the PtDA intervention or usual education. The intervention was an osteoarthritis PtDA for patients and a one-page preference report summarizing patients’ clinical and decisional data for their surgeon. The main feasibility outcomes were rates of recruitment and questionnaire completion; the preliminary effectiveness outcomes were wait times and decision quality.

Results

Of 180 patients eligible for surgical consultation, 142 (79%) were recruited and randomized to the PtDA intervention (n = 71) or usual education (n = 71). Data collection yielded a 93% questionnaire completion rate with less than 1% missing items. After one year, 13% of patients remained on the surgical wait list. The median time from referral to being off the wait list (censored using survival analysis techniques) was 33.4 weeks for the PtDA group (n = 69, 95% CI: 26.0, 41.4) and 33.0 weeks for usual education (n = 71, 95% CI: 26.1, 39.9). Patients exposed to the PtDA had higher decision quality based on knowledge (71% versus 47%; p < 0.0001) and quality decision being an informed choice that is consistent with their values for option outcomes (56.4% versus 25.0%; p < 0.001).

Conclusions

Recruitment of patients with osteoarthritis considering surgery and data collection were feasible. As some patients remained on the surgical waiting list after one year, follow-up should be extended to two years. Patients exposed to the PtDA achieved higher decision quality compared to those receiving usual education but there was no difference in wait for surgery.

Trials registration

ClinicalTrials.Gov NCT00743951

【 授权许可】

   
2014 Stacey et al.; licensee BioMed Central Ltd.

【 图 表 】

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