TY - JOUR
T1 - Implementation of a Decision Aid for Hip and Knee Osteoarthritis in Orthopedics
T2 - A Mixed-Methods Process Evaluation
AU - Bossen, Jeroen Klaas Jacobus
AU - Wesselink, Julia Aline
AU - Heyligers, Ide Christiaan
AU - Jansen, Jesse
N1 - Publisher Copyright:
© The Author(s) 2023.
PY - 2024/1
Y1 - 2024/1
N2 - Background: In orthopedics, the use of patient decision aids (ptDAs) is limited. With a mixed-method process evaluation, we investigated patient factors associated with accepting versus declining the use of the ptDA, patients’ reasons for declining the ptDA, and clinicians’ perceived barriers and facilitators for its use. Methods: Patients with an indication for joint replacement surgery (N = 153) completed questionnaires measuring demographics, physical functioning, quality of life (EQ-5D-3L), and a visual analog scale (VAS) pain score at 1 time point. Subsequently, their clinician offered them the relevant ptDA. Using a retrospective design, we compared patients who used the ptDA (59%) with patients who declined (41%) on all these measures as well as the chosen treatment. If the use of the ptDA was declined, patients’ reasons were recorded by their clinician and analysed (n = 46). To evaluate the experiences of clinicians (n = 5), semistructured interviews were conducted and thematically analyzed. Clinicians who did not use the ptDA substantially (<10 times) were also interviewed (n = 3). Results: Compared with patients who used the ptDA, patients who declined use had higher VAS pain scores (7.2 v. 6.2, P <.001), reported significantly worse quality of life (on 4 of 6 EQ-5D-3L subscales), and were less likely to receive nonsurgical treatment (4% v. 28%, P <.001). Of the patients who declined to use the ptDA, 46% said they had enough information and felt ready to make a decision without the ptDA. The interviews revealed that clinicians considered the ptDAs most useful for newly diagnosed patients who had not received previous treatment. Conclusion: These results suggest that the uptake of a ptDA may be improved if it is introduced in the early disease stages of hip and knee osteoarthritis. Patients who declined the use of a patient decision aid (ptDA) for hip and knee osteoarthritis reported more pain and worse quality of life. Most patients who declined to use a ptDA felt sufficiently well informed to make a treatment decision. Patients who declined the ptDA were more likely to have received prior treatment in primary care. Clinicians found the ptDA to be a helpful addition to the consultation, particularly for newly diagnosed patients.
AB - Background: In orthopedics, the use of patient decision aids (ptDAs) is limited. With a mixed-method process evaluation, we investigated patient factors associated with accepting versus declining the use of the ptDA, patients’ reasons for declining the ptDA, and clinicians’ perceived barriers and facilitators for its use. Methods: Patients with an indication for joint replacement surgery (N = 153) completed questionnaires measuring demographics, physical functioning, quality of life (EQ-5D-3L), and a visual analog scale (VAS) pain score at 1 time point. Subsequently, their clinician offered them the relevant ptDA. Using a retrospective design, we compared patients who used the ptDA (59%) with patients who declined (41%) on all these measures as well as the chosen treatment. If the use of the ptDA was declined, patients’ reasons were recorded by their clinician and analysed (n = 46). To evaluate the experiences of clinicians (n = 5), semistructured interviews were conducted and thematically analyzed. Clinicians who did not use the ptDA substantially (<10 times) were also interviewed (n = 3). Results: Compared with patients who used the ptDA, patients who declined use had higher VAS pain scores (7.2 v. 6.2, P <.001), reported significantly worse quality of life (on 4 of 6 EQ-5D-3L subscales), and were less likely to receive nonsurgical treatment (4% v. 28%, P <.001). Of the patients who declined to use the ptDA, 46% said they had enough information and felt ready to make a decision without the ptDA. The interviews revealed that clinicians considered the ptDAs most useful for newly diagnosed patients who had not received previous treatment. Conclusion: These results suggest that the uptake of a ptDA may be improved if it is introduced in the early disease stages of hip and knee osteoarthritis. Patients who declined the use of a patient decision aid (ptDA) for hip and knee osteoarthritis reported more pain and worse quality of life. Most patients who declined to use a ptDA felt sufficiently well informed to make a treatment decision. Patients who declined the ptDA were more likely to have received prior treatment in primary care. Clinicians found the ptDA to be a helpful addition to the consultation, particularly for newly diagnosed patients.
KW - evaluation study
KW - orthopeadics
KW - patient decision aids
KW - shared decision-making
U2 - 10.1177/0272989X231205858
DO - 10.1177/0272989X231205858
M3 - Article
SN - 0272-989X
VL - 44
SP - 112
EP - 122
JO - Medical Decision Making
JF - Medical Decision Making
IS - 1
ER -