HIP AND KNEE OSTEOARTHRITIS: CAN DECISION AIDS INFLUNCE PATIENT TREATMENT CHOICE AND SATISFACTION WITH OUTCOMES?

Purpose: The purpose of this study was to examine the influence of a video decision aid (DA) on decision making and satisfaction with treatment for patients with hip or knee osteoarthritis.  

Method: Patients with hip or knee osteoarthritis complete self-reported intake and follow up questionnaires as a part of usual care at a hip and knee clinic in an academic medical center. A subset of patients receives a hip or knee video decision aid that reviews treatment options, benefits, and risks. The DA may be prescribed prior to or after the self-reported questionnaires are completed.  Study design: retrospective observational cohort.  Measures: demographic and clinical characteristics, treatment intention (Surgery, Non-surgical treatment, Unsure), treatments received.  Preoperative expectations were quantified using the MODEMS questionnaire (MEXP), scale: 0 (not at all likely) – 100 (extremely likely).  Satisfaction was assessed using the MODEMS satisfaction (MSAT), scale: 0 (not at all satisfied) – 100 (extremely satisfied).

Result: 774 patients completed an initial and at least 1 follow up questionnaire; 75 (10%) had borrowed a DA before their initial survey, while 186 (24%) had a DA loan before their follow up survey.  No differences in age, gender, education, or SF12 scores were observed for patients with a DA loan compared to those without a loan (p ≥ 0.24). Patients with a DA were less unsure about their treatment choice (4% vs 28% unsure); and more likely to follow through with their treatment intention (88% of DA patients who were leaning toward surgery got surgery, compared to 68% for patients without a loan, p ≤ 0.001). Patients with a DA loan had higher expectations for treatment success (DA MEXP: 85 compared to 79, p ≤ 0.01).   Satisfaction with treatment was also higher for patients with a DA loan (MSAT=89 vs. 83, p = 0.01).  DA patients indicated they would choose the same treatment again (90%) more often than patients that did not have a DA loan (83%).

Conclusion: Patients receiving a decision aid were more confident in their decision making and more likely to follow through with their chosen treatment.  Follow up surveys revealed that these patients were also more satisfied with their treatment decision.  These results suggest that DAs have a beneficial influence on the decision process and downstream patient satisfaction.