Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2021 Dec 18;12(12):1026-1035.
doi: 10.5312/wjo.v12.i12.1026.

Decision aids can decrease decisional conflict in patients with hip or knee osteoarthritis: Randomized controlled trial

Lode A van Dijk  1 , Antonius Mjs Vervest  2 , Dominique C Baas  2 , Rudolf W Poolman  3 , Daniel Haverkamp  4
Affiliations

Decision aids can decrease decisional conflict in patients with hip or knee osteoarthritis: Randomized controlled trial

Lode A van Dijk et al. World J Orthop. .

Abstract

Background: The interest in shared decision making has increased considerably over the last couple of decades. Decision aids (DAs) can help in shared decision making. Especially when there is more than one reasonable option and outcomes between treatments are comparable.

Aim: To investigate if the use of DAs decreases decisional conflict in patients when choosing treatment for knee or hip osteoarthritis (OA).

Methods: In this multi-center unblinded randomized controlled trial of patients with knee or hip OA were included from four secondary and tertiary referral centers. One-hundred-thirty-one patients who consulted an orthopedic surgeon for the first time with knee or hip OA were included between December 2014 and January 2016. After the first consultation, patients were randomly assigned by a computer to the control group which was treated according to standard care, or to the intervention group which was treated with standard care and provided with a DA. After the first consultation, patients were asked to complete questionnaires about decisional conflict (DCS), satisfaction, anxiety (PASS-20), gained knowledge, stage of decision making and preferred treatment. Follow-up was carried out after 26 wk and evaluated decisional conflict, satisfaction, anxiety, health outcomes (HOOS/KOOS), quality of life (EQ5D) and chosen treatment.

Results: After the first consultation, patients in the intervention group (mean DCS: 25 out of 100, SD: 13) had significantly (P value: 0.00) less decisional conflict compared to patients in the control group (mean DCS: 39 out of 100, SD 11). The mean satisfaction score for the given information (7.6 out of 10, SD: 1.8 vs 8.6 out of 10, SD: 1.1) (P value: 0.00), mean satisfaction score with the physician (8.3 out of 10, SD: 1.7 vs 8.9 out of 10, SD: 0.9) (P value: 0.01) and the mean knowledge score (3.3 out of 4, SD: 0.9 vs 3.7 out of, SD: 0.6) (P value: 0.01) were all significantly higher in the intervention group. At 26-wk follow-up, only 75 of 131 patients (57%) were available for analysis. This sample is too small for meaningful analysis.

Conclusion: Providing patients with an additional DA may have a positive effect on decisional conflict after the first consultation. Due to loss to follow-up we are unsure if this effect remains over time.

Keywords: Anxiety; Decision aid; Decisional conflict; Hip osteoarthritis; Knee osteoarthritis; Shared decision making.

PubMed Disclaimer

Conflict of interest statement

Conflict-of-interest statement: There is no conflict-of-interest.

Figures

Figure 1
Figure 1
Flow of the patients in the study.
See this image and copyright information in PMC

References

    1. Skou ST, Roos EM, Laursen MB, Rathleff MS, Arendt-Nielsen L, Simonsen O, Rasmussen S. A Randomized, Controlled Trial of Total Knee Replacement. N Engl J Med . 2015;373:1597–1606. - PubMed
    1. American Association of Orthopaedic Surgeons. Shared Physician-Patient Responsibilities. [cited 20 March 2021]. In: AAOS website [Internet]. Available from: https://www.aaos.org/globalassets/about/position-statements/1182-shared-... .
    1. du Long, J , Hageman , M , Vuijk , D , Rakic A, Haverkamp D. Facing the decision about the treatment of hip or knee osteoarthritis: What are patients’ needs? Sport Traumatol Arthrosc . 2016;24:1710–1716. - PubMed
    1. Slover J, Shue J, Koenig K. Shared decision-making in orthopaedic surgery. Clin Orthop Relat Res . 2012;470:1046–1053. - PMC - PubMed
    1. Stacey D, Légaré F, Lewis K, Barry MJ, Bennett CL, Eden KB, Holmes-Rovner M, Llewellyn-Thomas H, Lyddiatt A, Thomson R, Trevena L. Decision aids for people facing health treatment or screening decisions. Cochrane Database Syst Rev . 2017;4:CD001431. - PMC - PubMed