Candidate for the Lee B. Lusted Student Prize Competition
Purpose: To examine the impact of a decision aid coupled with an adaptive conjoint analysis (ACA) program on decisional conflict in decision making for treatment of osteoarthritis (OA).
Method: A total of 209 patients with OA in one or both knees who had not undergone total knee arthroplasty (TKA), but had thought about it or had talked to their doctor about it participated in the study (mean age 63 years; 68% female; 66% White). Participants were randomly allocated into one of three groups: 1) a control arm brochure, 2) a DVD-based decision aid, and 3) the same DVD-based decision aid plus the ACA program. The primary outcome measure [decisional conflict scale (DCS)] was evaluated using pre/post intervention self-administered questionnaires along with demographic characteristics and impact of OA on quality of life (KOOS). Statistical analysis included descriptive statistics and analysis of variance (ANOVA) to estimate the effect of the intervention on decisional conflict.
Result: Overall, the intervention statistically significantly reduced decisional conflict in all groups (p<0.05). The difference between the pre and post mean subscale scores for the DCS measured change in the expected direction: decision uncertainty decreased, informativeness increased, values clarity increased, support increased and effective decision increased. The largest reduction in decision conflict was observed for participants in the DVD decision aid group. Post hoc analyses indicated a statistically significant difference in pre vs. post-intervention DCS total score comparing the DVD group to the control group and comparing the DVD group to the DVD plus ACA group (p<0.001). The changes in decision conflict for the control compared to the DVD decision aid plus ACA group were not significantly different.
Conclusion: In this study, the addition of an ACA program to a DVD decision aid did not lead to greater reductions in decisional conflict. Long-term effectiveness is yet to be determined and should take into account additional patient and provider preferences.