Patient decision aids can reduce uncertainty in decisions about whether to undergo total knee replacement
Research Activities, November 2012, No. 387
Total knee arthroplasty (TKA) is a serious medical procedure that results in substantial pain relief and functional improvement for the patient. Despite its benefits, TKA is not without risks and, since it is an elective procedure, patients with advanced knee osteoarthritis must carefully weigh potential benefits and risks. A new study found that certain patient decision aids can reduce the level of uncertainty or "decisional conflict." Researchers tested three types of patient decision aids in a group of patients with knee osteoarthritis (OA) who were considering TKA. They examined scores on a decisional conflict scale ranging from 0 (no conflict) to 100 (most conflict). They found a 21-point reduction in decisional conflict in the group receiving a video booklet compared with two other groups receiving the video booklet plus the adaptive conjoint analysis (ACA) tool (14-point reduction) or an educational booklet on OA management (10-point reduction).
ACA is a specific type of analysis to describe patient preferences and values affecting decisionmaking in rheumatic conditions. ACA collects and analyzes preference data using an interactive computer program that uses an individual respondent's answers to update and refine questions through a series of paired comparisons.
One reason why participants who used both the videobooklet and the ACA did not experience a reduction in decisional conflict may have been fatigue (doing both took an average of 2 hours compared to 1 hour for the videobooklet alone). Another reason may have been the cognitive rigor of the ACA, which could have reduced clarity about the decision, increasing uncertainty. The 208 participants were more than 55 years of age, mostly female, and with a high prevalence of obesity—characteristics that are representative of patients with knee OA. This study was supported by the Agency for Healthcare Research and Quality (HS16093).
See "Impact of educational and patient decision aids on decisional conflict associated with total knee arthroplasty" by Sofia de Achaval, M.S., Laina Fraenkel, M.D., Robert J. Volk, PhD, and others in the February 2012 Arthritis Care & Research 64(2), pp. 229-237.