Decision Aid for Trapeziometacarpal Arthritis: A Randomized Controlled Trial

Abstract

Purpose: Decision aids increase patient participation in decision making and reduce decision conflict. The goal of this study was to evaluate the effect of a decision aid prior to the appointment, upon decisional conflict measured immediately after the visit relative to usual care. We also evaluated other effects of the decision aid over time.

Methods: In this randomized controlled trial, we included 90 patients seeking the care of a hand surgeon for trapeziometacarpal (TMC) arthritis for the first time. Patients were randomly assigned to receive either usual care (an informational brochure) or an interactive Web-based decision aid. At enrollment, consult duration was recorded, and patients completed the following measures: (1) Decisional Conflict Scale; (2) Quick Disabilities of Arm, Shoulder, and Hand (QuickDASH); (3) pain intensity; (4) Physical Health Questionnaire (PHQ-2); (5) satisfaction with the visit; and (6) Consultation And Relational Empathy (CARE) scale. At 6 weeks and 6 months, patients completed: (1) pain intensity measure; (2) Decision Regret Scale; and (3) satisfaction with treatment. We also recorded changes in treatment and provider.

Results: Patients who reviewed the interactive decision aid prior to visiting their hand surgeon had less decisional conflict at the end of the visit. Other outcomes were not affected.

Conclusions: Use of a decision aid prior to a first-time visit for TMC led to a measurable reduction in decision conflict. Decision aids make people seeking care for TMC arthritis more comfortable with their decision making. Future research might address the ability of decision aids to reduce surgeon-to-surgeon variation, resource utilization, and dissatisfaction with care CLINICAL RELEVANCE: Surgeons should consider the routine use of decision aids to reduce decision conflict.

Keywords: Decision aid; decisional conflict; patient values; trapeziometacarpal arthritis; treatment choice.