Thursday, October 18, 2012: 1:30 PM
Regency Ballroom A/B (Hyatt Regency)
Decision Psychology and Shared Decision Making (DEC)
Candidate for the Lee B. Lusted Student Prize Competition

Aubri S. Hoffman, PhD1, Hilary A. Llewellyn-Thomas, PhD1, Anna N.A. Tosteson, ScD2, Ivan Tomek, MD3, Robert J. Volk, PhD4 and Annette M. O'Connor, PhD5, (1)The Geisel School of Medicine at Dartmouth, Lebanon, NH, (2)The Dartmouth Institute for Health Policy & Clinical Practice, Lebanon, NH, (3)Dartmouth Hitchcock Medical Center, Lebanon, NH, (4)The University of Texas MD Anderson Cancer Center, Houston, TX, (5)University of Ottawa, Ottawa, ON, Canada

Purpose:    The purpose of this study was to develop and evaluate an Internet-based patients’ decision aid (PtDA) for surgical versus nonsurgical management of knee pain due to chronic osteoarthritis.

Method:    We created an Internet-based PtDA that provided a) up-to-date, balanced clinical information, and b) decision support in four theory-based deliberative steps: 1) information comprehension; 2) values clarification; 3) consideration of personal resources; and 4) formation of an action plan.  Clinical information was abstracted from original sources cited in existing paper- and video-based PtDAs for knee osteoarthritis, and updated to reflect current literature. Information was presented in lay language with optional audio narration.  After pilot testing, patients were recruited who were eligible for and actively considering knee surgery.  Participants were offered a computer in a private room at the clinic to complete and evaluate the PtDA in terms of: a) usability (5 items); b) post-PtDA Information Comprehension (5 items), Preparation for Decision Making, and Decision Self-efficacy; and c) pre/post-PtDA Decisional Conflict and treatment preferences.

Result:    126 patients participated.    Usability: Participants reported that: the PtDA was easy to use (98%), the information was clear (90%), the length was appropriate (100%), it was appropriately detailed (90%), and it held their interest (97%).  100% of participants preferred using the PtDA on a home or public computer rather than at the clinic.    Post-PtDA Information Comprehension, Preparation for Decision Making, Decision Self-Efficacy: Participants scored an average of 75% (min. 60%; max. 100%) correct responses. The median Preparation for Decision Making score was 74 (interquartile range = 30). The median Decision Self-efficacy score was 100 (interquartile range = 13.6).    Pre/post-PtDA Decisional Conflict, Treatment Preferences: Viewing the PtDA reduced Decisional Conflict scores from 31.1 to 19.53 (p < 0.01).  At baseline, 63.5% preferred nonsurgical therapies, 15.1% were unsure/no preference, and 21.4% preferred surgery; of those with a stated preference, 67.5% held that preference strongly, and 11.8% held it weakly.  After viewing the PtDA, similar percentages of those who had been “unsure/no preference” shifted to the nonsurgical (42%) and the surgical (47%) preference sub-groups, and their strength of preference scores increased.   

Conclusion:    An Internet-based PtDA is usable and effective for patients considering surgical versus nonsurgical management of knee pain due to osteoarthritis.