13CEP HIP AND KNEE OSTEOARTHRITIS: CAN DECISION AIDS HELP PATIENTS MAKE A QUALITY TREATMENT CHOICE?

Monday, October 19, 2009
Grand Ballroom, Salons 1 & 2 (Renaissance Hollywood Hotel)
Catharine F. Clay, MA, BSN1, Ivan Tomek, MD1, Stephen Kantor, MD1 and Stephen Kearing, MS2, (1)Dartmouth Hitchcock Medical Center, Lebanon, NH, (2)Dartmouth Medical School, Lebanon, NH

Purpose: Decision aids educate patients about medical decisions that they are facing and have been shown to increase satisfaction with treatment across diverse disciplines.  The purpose of this prospective observational study was to determine if a video decision aid (DA) could be used to help patients with severely symptomatic hip or knee arthritis make a high quality treatment choice.

Method: Patients with severely symptomatic hip (n=84) or knee osteoarthritis (n=149) were prospectively enrolled once their surgeon deemed that they were candidates for total joint replacement. All participants: (1) completed a pre-video questionnaire (2) viewed a hip or knee video decision aid that reviewed treatment option benefits and risks and (3) completed a follow-up questionnaire.  A chart review was conducted to determine if patients followed through with their choice within 3 months of watching the decision aid.  Measures: treatment intention and choice, values influencing decision (visual analog: 1-10 importance), patient osteoarthritis knowledge (multiple choice), and DA acceptability.

Result: Fewer patients were unsure about their treatment preference after watching the video decision aid (19% before vs. 13% after). Patients who had decided on treatment before the DA, tended to retain their preferred option after the video (92% continued to prefer surgery, 92% continued to prefer non-surgical treatment).  Patients were also likely to adhere to their post-DA choice (82% leaning toward surgery and 92% leaning toward non-surgical followed through with the respective treatments).  Most patients understood key facts associated with their decision (Hip: 83%, Knee: 81%) and chose the treatment that matched their personal values (Hip: 81%, Knee: 85%).  Participants indicated that both DAs had appropriate content (85%) with an average rating of “Very Good”.

Conclusion: Decision quality is a function of sufficient knowledge, clear values and acting upon one’s choice. Video decision aids helped these patients make a high quality treatment choice for their osteoarthritis. After watching the DA, most patients understood treatment options, benefits and risks, were clear about their personal values, and followed through with their chosen treatment.

Candidate for the Lee B. Lusted Student Prize Competition