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Monday, October 20, 2008
Columbus A-C (Hyatt Regency Penns Landing)
Purpose: To evaluate the effect of a patient decision aid on wait times and decision quality for patients considering total knee arthroplasty.
Results: Of 116 patients (59 decision aid; 57 usual education), 104 completed questionnaires in the post clinic telephone interview. Of 12 incomplete, 6 were not contactable by phone, 2 saw surgeon before reviewing education materials, 1 was visually impaired, 1 died, 1 withdrew, and 1 questionnaire was lost in the mail. Preliminary analysis indicates that wait times: from referral to surgeon consultation (or removal from wait list) were median 9.9 weeks for decision aid group (n=46) and 9.3 weeks for usual education group (n=50); and from consult to surgery (or removal from wait list) were 12.1 weeks for decision aid group (n=18) and 15.7 weeks for usual education group (n=18). Surgery rates were 17 of 18 (94%) for usual education group compared to 16 of 18 (89%) for decision aid group. Patients who used the decision aid were more knowledgeable (71% versus 47%) and more likely to achieve decision quality (informed choice matched values associated with outcomes of options) prior to surgeon consult (26/59; 54%) compared to patients who received usual education (12/57; 25%).
Methods: Patients with knee osteoarthritis waiting for a surgical consultation were screened for surgical eligibility by a general practitioner using a standardized physical and symptom assessment. Surgically eligible patients were randomly allocated to: a) usual education - booklet about knee replacement; or b) patient decision aid - evidence-based DVD with options for knee osteoarthritis and personal decision form eliciting knowledge, values, and preferences. Orthopaedic surgeons received automated reports with clinical screening data (both groups) and personal decision data (decision aid only). Decision aid participants who did not prefer surgery were sent back to their referring physician with these automated reports.
Results: Of 116 patients (59 decision aid; 57 usual education), 104 completed questionnaires in the post clinic telephone interview. Of 12 incomplete, 6 were not contactable by phone, 2 saw surgeon before reviewing education materials, 1 was visually impaired, 1 died, 1 withdrew, and 1 questionnaire was lost in the mail. Preliminary analysis indicates that wait times: from referral to surgeon consultation (or removal from wait list) were median 9.9 weeks for decision aid group (n=46) and 9.3 weeks for usual education group (n=50); and from consult to surgery (or removal from wait list) were 12.1 weeks for decision aid group (n=18) and 15.7 weeks for usual education group (n=18). Surgery rates were 17 of 18 (94%) for usual education group compared to 16 of 18 (89%) for decision aid group. Patients who used the decision aid were more knowledgeable (71% versus 47%) and more likely to achieve decision quality (informed choice matched values associated with outcomes of options) prior to surgeon consult (26/59; 54%) compared to patients who received usual education (12/57; 25%).
Conclusions: Patients who used the decision aid appeared to have a shorter wait and achieve higher quality decisions.
See more of: Poster Session II
See more of: 30th Annual Meeting of the Society for Medical Decision Making (October 19-22, 2008)