Purpose: To assess the quality of decisions for treatment of hip and knee osteoarthritis (OA). A high quality decision is one in which the patient is well informed and receives treatment tailored to his/her goals.
Method: A mailed survey of hip and knee OA patients who either had or discussed total joint replacement (TJR) with a doctor within the last 2 years. Eligible participants were recruited from three hospitals and from responders to newspaper ads. The survey included questions to assess knowledge, goals and concerns, preferred treatment and involvement in the decision. It also included demographics, quality of life, how informed and confident patients felt (both on a scale of 0 not at all to 10 extremely), and regret.
Result: 386 eligible patients responded (RR 79%). The sample was on average 63 (SD 10) years old and 234 (61%) had surgery. Surgical patients had significantly higher SF-12 physical component score (45 vs. 36, p<0.001) compared to non-surgical patients. Surgical patients had higher total knowledge scores than non-surgical patients (63.5% vs. 56%, p=.001). In multivariate linear regression, site, higher education and surgery were positively associated with knowledge. Patients who had surgery were more likely to rate “relieve pain” and “not be limited because of pain” as extremely important goals compared to non-surgical patients (79% vs. 57%, p<0.001; 87% vs. 59%, p<0.001). Non-surgical patients were more likely to rate “avoid surgery” as an extremely important goal (30% vs. 10%, p<0.001). More surgical patients received treatment that matched their preferred treatment (80% vs. 64%, p<0.001). Surgical patients reported higher confidence in their decision (9.2 vs. 7.4, p<0.001) and felt more informed (8.8 vs. (7.4, p<0.001). Surgical patients also reported less regret about their decision, with 76% of surgical patients indicating they would definitely do the same thing again, compared to 41% of non-surgical patients (p<0.001). The relationship between surgery and regret persisted after controlling for joint (hip or knee), knowledge, and SF-12 PCS scores.
Conclusion: In this retrospective study, patients who had TJR reported higher quality decision making compared to non-surgical patients. Osteoarthritis patients, particularly those who choose non-surgical treatments, may benefit from decision support interventions to increase knowledge and confidence in their choices.
See more of: The 32nd Annual Meeting of the Society for Medical Decision Making