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. 2014 Aug 31:14:366.
doi: 10.1186/1472-6963-14-366.

Patient, surgeon, and healthcare purchaser views on the use of decision and communication aids in orthopaedic surgery: a mixed methods study

Kevin J Bozic  1 , Kate Eresian Chenok, Jennifer Schindel, Vanessa Chan, James I Huddleston 3rd, Clarence Braddock 3rd, Jeffrey Belkora
Affiliations

Patient, surgeon, and healthcare purchaser views on the use of decision and communication aids in orthopaedic surgery: a mixed methods study

Kevin J Bozic et al. BMC Health Serv Res. .

Abstract

Background: Despite evidence that decision and communication aids are effective for enhancing the quality of preference-sensitive decisions, their adoption in the field of orthopaedic surgery has been limited. The purpose of this mixed-methods study was to evaluate the perceived value of decision and communication aids among different healthcare stakeholders.

Methods: Patients with hip or knee arthritis, orthopaedic surgeons who perform hip and knee replacement procedures, and a group of large, self-insured employers (healthcare purchasers) were surveyed regarding their views on the value of decision and communication aids in orthopaedics. Patients with hip or knee arthritis who participated in a randomized controlled trial involving decision and communication aids were asked to complete an online survey about what was most and least beneficial about each of the tools they used, the ideal mode of administration of these tools and services, and their interest in receiving comparable materials and services in the future. A subset of these patients were invited to participate in a telephone interview, where there were asked to rank and attribute a monetary value to the interventions. These interviews were analyzed using a qualitative and mixed methods analysis software. Members of the American Hip and Knee Surgeons (AAHKS) were surveyed on their perceptions and usage of decision and communication aids in orthopaedic practice. Healthcare purchasers were interviewed about their perspectives on patient-oriented decision support.

Results: All stakeholders saw value in decision and communication aids, with the major barrier to implementation being cost. Both patients and surgeons would be willing to bear at least part of the cost of implementing these tools, while employers felt health plans should be responsible for shouldering the costs.

Conclusions: Decision and communication aids can be effective tools for incorporating patients preferences and values into preference-sensitive decisions in orthopaedics. Future efforts should be aimed at assessing strategies for efficient implementation of these tools into widespread orthopaedic practice.

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Figures

Figure 1
Figure 1
Factors that affect recommendations regarding hip or knee replacement. “1” factor that most strongly affects your recommendations. “8” factor that least affects your recommendations.
Figure 2
Figure 2
Purchaser’s definition of value for decision and communication aids. Note: multiple responses allowed. N=12.
Figure 3
Figure 3
Purchaser’s opinions on who should pay for programs and tools to help employees make more informed medical decisions. Note: multiple responses allowed. N=12.
See this image and copyright information in PMC

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Pre-publication history
    1. The pre-publication history for this paper can be accessed here:http://www.biomedcentral.com/1472-6963/14/366/prepub

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