Decision Support Strategies for Hip and Knee Osteoarthritis: Less Is More

• DOI: 10.2106/jbjs.19.00004
• Publication Date: 2019-09-25T15:13:16Z
• Authors: Karen Sepucha; Hany Bedair; Liyang Yu; Janet M. Dorrwachter; Maureen Dwyer; Carl T. Talmo; Ha Vo; Andrew A. Freiberg
• Keywords: Decision aids

Background: As guidelines and payers increasingly recommend use of patient decision aids (DAs), evidence about the comparative effectiveness available DAs is critical for organizations interested in implementing them. The primary purpose this study was to compare 2 with regard their ability help patients become informed receive preferred treatment (that is, make an patient-centered decision), shared decision-making, surgical rates, surgeon satisfaction. Methods: We performed a multisite factorial randomized trial enrolling hip or knee osteoarthritis. Patients were randomly assigned long, detailed DA (long DA) short, interactive (short DA). Eight surgeons preference report detailing patient’s goals preferences administer usual care. Results: distributed 1,636 pre-visit surveys, 1,220 which returned (75% response rate), 1,124 post-visit 967 (86% rate). sample had mean age (and standard deviation) 65 ± 10 years, 57% female, 89% white non-Hispanic, 67% majority (67.2%) made decisions, rate did not vary significantly between groups (p = 0.97) 0.23). Knowledge scores higher short-DA group (mean difference 9%; p < 0.001). More than half (60.5%) surgery within 6 months after visit, rates differ by group. Overall, highly satisfied reported that (88.7%) visits normal duration shorter. Conclusions: DECIDE-OA our knowledge, first orthopaedic DAs. short outperformed long knowledge comparable respect other outcomes. high satisfaction visit both Clinical Relevance: Surgeons need ensure osteoarthritis are well-informed have clear regarding whether undergo replacement surgery. used may involve elective decisions meet requirements consent.