BACKGROUND: Shared decision making requires informing patients and ensuring that treatment decisions reflect their goals. It is not clear to what extent this happens for patients considering total joint replacement (TJR) for hip or knee osteoarthritis. STUDY DESIGN: We conducted a cross-sectional mail survey of osteoarthritis patients at 4 sites, who made a decision about TJR. The survey measured knowledge and goals, the decision making process, decision confidence, and decision regret. Decision quality was defined as the percentage of patients who had high knowledge scores and received treatments that matched their goals. Multivariable regression models examined factors associated with knowledge and decision quality. RESULTS: There were 382 patients who participated (78.6% response rate). Mean knowledge score was 61% (SD 20.7%). In multivariate linear regression, higher education, having TJR, and site were associated with higher knowledge. Many patients (73%) received treatments that matched their goals. Thirty-one percent of patients met our definition for high decision quality. Higher decision making process scores, higher quality of life scores, and site were associated with higher decision quality. Patients who had high decision quality had less regret (73.1% vs 58.5%, p = 0.007) and greater confidence (9.0 [SD 1.6] vs 8.2 [SD 2.3] out of 10, p < 0.001). CONCLUSIONS: A third of patients who recently made a decision about osteoarthritis treatment met both criteria for a high quality decision. Controlling for treatment, patients reporting more involvement in the decision making process, higher quality of life, and being seen at a site that uses decision aids were associated with higher decision quality.
BACKGROUND: Shared decision making requires informing patients and ensuring that treatment decisions reflect their goals. It is not clear to what extent this happens for patients considering total joint replacement (TJR) for hip or knee osteoarthritis. STUDY DESIGN: We conducted a cross-sectional mail survey of osteoarthritispatients at 4 sites, who made a decision about TJR. The survey measured knowledge and goals, the decision making process, decision confidence, and decision regret. Decision quality was defined as the percentage of patients who had high knowledge scores and received treatments that matched their goals. Multivariable regression models examined factors associated with knowledge and decision quality. RESULTS: There were 382 patients who participated (78.6% response rate). Mean knowledge score was 61% (SD 20.7%). In multivariate linear regression, higher education, having TJR, and site were associated with higher knowledge. Many patients (73%) received treatments that matched their goals. Thirty-one percent of patients met our definition for high decision quality. Higher decision making process scores, higher quality of life scores, and site were associated with higher decision quality. Patients who had high decision quality had less regret (73.1% vs 58.5%, p = 0.007) and greater confidence (9.0 [SD 1.6] vs 8.2 [SD 2.3] out of 10, p < 0.001). CONCLUSIONS: A third of patients who recently made a decision about osteoarthritis treatment met both criteria for a high quality decision. Controlling for treatment, patients reporting more involvement in the decision making process, higher quality of life, and being seen at a site that uses decision aids were associated with higher decision quality.
Authors: Karen R Sepucha; Aisha T Langford; Jeffrey K Belkora; Yuchiao Chang; Beverly Moy; Ann H Partridge; Clara N Lee Journal: Med Decis Making Date: 2019-07-29 Impact factor: 2.583
Authors: Eric R Henderson; Alexander J Titus; Benjamin J Keeney; Philip P Goodney; Jon D Lurie; Said A Ibrahim Journal: Mil Med Date: 2018-07-01 Impact factor: 1.437
Authors: G Filardo; A Roffi; G Merli; T Marcacci; F Berti Ceroni; D Raboni; E Kon; M Marcacci Journal: Knee Surg Sports Traumatol Arthrosc Date: 2017-01-03 Impact factor: 4.342
Authors: Marie-Anne Durand; Julia Song; Renata West Yen; Karen Sepucha; Mary C Politi; Shubhada Dhage; Kari Rosenkranz; Julie Margenthaler; Anna N A Tosteson; Eloise Crayton; Sherrill Jackson; Ann Bradley; A James O'Malley; Robert J Volk; Elissa Ozanne; Sanja Percac-Lima; Jocelyn Acosta; Nageen Mir; Peter Scalia; Abigail Ward; Glyn Elwyn Journal: MDM Policy Pract Date: 2018-11-25
Authors: Mahima Mangla; Hany Bedair; Yuchiao Chang; Susannah Daggett; Maureen K Dwyer; Andrew A Freiberg; Sheila Mwangi; Carl Talmo; Ha Vo; Karen Sepucha Journal: BMJ Open Date: 2019-02-24 Impact factor: 2.692