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Decision aid for patients considering total knee arthroplasty with preference report for surgeons: a pilot randomized controlled trial
BACKGROUND: To evaluate feasibility and potential effectiveness of a patient decision aid (PtDA) for patients and a preference report for surgeons to reduce wait times and improve decision quality in patients with osteoarthritis considering total knee replacement. METHODS: A prospective two-arm pilo...
Autores principales: | , , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
BioMed Central
2014
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3937455/ https://www.ncbi.nlm.nih.gov/pubmed/24564877 http://dx.doi.org/10.1186/1471-2474-15-54 |
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author | Stacey, Dawn Hawker, Gillian Dervin, Geoffrey Tugwell, Peter Boland, Laura Pomey, Marie-Pascale O’Connor, Annette M Taljaard, Monica |
author_facet | Stacey, Dawn Hawker, Gillian Dervin, Geoffrey Tugwell, Peter Boland, Laura Pomey, Marie-Pascale O’Connor, Annette M Taljaard, Monica |
author_sort | Stacey, Dawn |
collection | PubMed |
description | BACKGROUND: To evaluate feasibility and potential effectiveness of a patient decision aid (PtDA) for patients and a preference report for surgeons to reduce wait times and improve decision quality in patients with osteoarthritis considering total knee replacement. METHODS: A prospective two-arm pilot randomized controlled trial. Patients with osteoarthritis were eligible if they understood English and were referred for surgical consultation about an initial total knee arthroplasty at a Canadian orthopaedic joint assessment clinic. Patients were randomized to the PtDA intervention or usual education. The intervention was an osteoarthritis PtDA for patients and a one-page preference report summarizing patients’ clinical and decisional data for their surgeon. The main feasibility outcomes were rates of recruitment and questionnaire completion; the preliminary effectiveness outcomes were wait times and decision quality. RESULTS: Of 180 patients eligible for surgical consultation, 142 (79%) were recruited and randomized to the PtDA intervention (n = 71) or usual education (n = 71). Data collection yielded a 93% questionnaire completion rate with less than 1% missing items. After one year, 13% of patients remained on the surgical wait list. The median time from referral to being off the wait list (censored using survival analysis techniques) was 33.4 weeks for the PtDA group (n = 69, 95% CI: 26.0, 41.4) and 33.0 weeks for usual education (n = 71, 95% CI: 26.1, 39.9). Patients exposed to the PtDA had higher decision quality based on knowledge (71% versus 47%; p < 0.0001) and quality decision being an informed choice that is consistent with their values for option outcomes (56.4% versus 25.0%; p < 0.001). CONCLUSIONS: Recruitment of patients with osteoarthritis considering surgery and data collection were feasible. As some patients remained on the surgical waiting list after one year, follow-up should be extended to two years. Patients exposed to the PtDA achieved higher decision quality compared to those receiving usual education but there was no difference in wait for surgery. TRIALS REGISTRATION: ClinicalTrials.Gov NCT00743951 |
format | Online Article Text |
id | pubmed-3937455 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2014 |
publisher | BioMed Central |
record_format | MEDLINE/PubMed |
spelling | pubmed-39374552014-03-01 Decision aid for patients considering total knee arthroplasty with preference report for surgeons: a pilot randomized controlled trial Stacey, Dawn Hawker, Gillian Dervin, Geoffrey Tugwell, Peter Boland, Laura Pomey, Marie-Pascale O’Connor, Annette M Taljaard, Monica BMC Musculoskelet Disord Research Article BACKGROUND: To evaluate feasibility and potential effectiveness of a patient decision aid (PtDA) for patients and a preference report for surgeons to reduce wait times and improve decision quality in patients with osteoarthritis considering total knee replacement. METHODS: A prospective two-arm pilot randomized controlled trial. Patients with osteoarthritis were eligible if they understood English and were referred for surgical consultation about an initial total knee arthroplasty at a Canadian orthopaedic joint assessment clinic. Patients were randomized to the PtDA intervention or usual education. The intervention was an osteoarthritis PtDA for patients and a one-page preference report summarizing patients’ clinical and decisional data for their surgeon. The main feasibility outcomes were rates of recruitment and questionnaire completion; the preliminary effectiveness outcomes were wait times and decision quality. RESULTS: Of 180 patients eligible for surgical consultation, 142 (79%) were recruited and randomized to the PtDA intervention (n = 71) or usual education (n = 71). Data collection yielded a 93% questionnaire completion rate with less than 1% missing items. After one year, 13% of patients remained on the surgical wait list. The median time from referral to being off the wait list (censored using survival analysis techniques) was 33.4 weeks for the PtDA group (n = 69, 95% CI: 26.0, 41.4) and 33.0 weeks for usual education (n = 71, 95% CI: 26.1, 39.9). Patients exposed to the PtDA had higher decision quality based on knowledge (71% versus 47%; p < 0.0001) and quality decision being an informed choice that is consistent with their values for option outcomes (56.4% versus 25.0%; p < 0.001). CONCLUSIONS: Recruitment of patients with osteoarthritis considering surgery and data collection were feasible. As some patients remained on the surgical waiting list after one year, follow-up should be extended to two years. Patients exposed to the PtDA achieved higher decision quality compared to those receiving usual education but there was no difference in wait for surgery. TRIALS REGISTRATION: ClinicalTrials.Gov NCT00743951 BioMed Central 2014-02-24 /pmc/articles/PMC3937455/ /pubmed/24564877 http://dx.doi.org/10.1186/1471-2474-15-54 Text en Copyright © 2014 Stacey et al.; licensee BioMed Central Ltd. http://creativecommons.org/licenses/by/2.0 This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly credited. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated. |
spellingShingle | Research Article Stacey, Dawn Hawker, Gillian Dervin, Geoffrey Tugwell, Peter Boland, Laura Pomey, Marie-Pascale O’Connor, Annette M Taljaard, Monica Decision aid for patients considering total knee arthroplasty with preference report for surgeons: a pilot randomized controlled trial |
title | Decision aid for patients considering total knee arthroplasty with preference report for surgeons: a pilot randomized controlled trial |
title_full | Decision aid for patients considering total knee arthroplasty with preference report for surgeons: a pilot randomized controlled trial |
title_fullStr | Decision aid for patients considering total knee arthroplasty with preference report for surgeons: a pilot randomized controlled trial |
title_full_unstemmed | Decision aid for patients considering total knee arthroplasty with preference report for surgeons: a pilot randomized controlled trial |
title_short | Decision aid for patients considering total knee arthroplasty with preference report for surgeons: a pilot randomized controlled trial |
title_sort | decision aid for patients considering total knee arthroplasty with preference report for surgeons: a pilot randomized controlled trial |
topic | Research Article |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3937455/ https://www.ncbi.nlm.nih.gov/pubmed/24564877 http://dx.doi.org/10.1186/1471-2474-15-54 |
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