Basic Science Tip #514
Patient Decision Aids: Less is More
There are numerous patients decision aids (DA) designed to assist patients in making decisions on medical treatment. Of interest to orthopaedic surgeons is the usefulness of these devices for patients making decisions about joint replacement surgery. Investigators hypothesized that: 1) use of the long, detailed DA would result in more informed patient-centered decisions and higher knowledge scores than the short DA, 2) use of the short, interactive DA would result in more patients having a clear treatment preference than the long DA, and 3) surgeon intervention (instead of usual care) would increase the number of patients receiving their preferred treatment (1).
This was a multisite study implementing 2 X 2 factorial randomized trial. That is, half of the patients had a short DA and the other a longer DA. These DAs were used just prior to the physician visit. Half of the members in each of the short and long DA groups had their report given to the physician prior to their physician visit. Patients were surveyed after the DA but before the physician visit, one week later, and then 6 months later (or six months after surgery if surgery was elected). The short DA (about 15 minutes) was “Knee Osteoarthritis: Is It Time to Think About Surgery? and “Hip Osteoarthritis: Is It Time to Think About Surgery?”. The long DAs (about 44 minutes) were “Treatment Choices for Knee Osteoarthritis,” and “Treatment Choices for Hip Osteoarthritis,”
Before the visit and after use of the DA, 40.7% of the patients met the criteria for informed patient-centered decisions and this was similar for short and long DAs. After the physician visit, 67.2% of the sample met the criteria for informed patient-centered decisions with rates similar for short and long DAs. Similarly more than one-third of the patients did not have a clear treatment preference prior to their physician visit and that decreased to 10.5% regardless of DA. The one difference was in was knowledge score which was higher with the short DA. Surgical rates were similar for the two DAs. Most surgeons were extremely or very satisﬁed with the visits and they reported visit durations either normal or shorter than normal.
Not all DA tools are equal. However, in a commentary it was noted that “In the era of shared decision-making it is crucially important that physicians are aware of the level of knowledge that their patients have, and a substantial amount of time can be shaved off visits by using decision aid tools such as the ones that the authors used in this trial.” (2) Although the short tool was as effective or more effective in the decision making process clinicians will still need to carefully select which tool they use.
1. Sepucha K, Bedair H, Yu L, Dorrwachter JM, Dwyer M, Talmo CT, Vo H, Freiberg AA. Decision Support Strategies for Hip and Knee Osteoarthritis: Less Is More A Randomized Comparative Effectiveness Trial (DECIDE-OA Study). J Bone Joint Surg Am. 2019;101 (Sept 18): 1645-1653
2. Castañeda P. Decision Support Aids for Hip and Knee Osteoarthritis. J Bone Joint Surg Am. 2019;101:e99(1-2)