Article

Impact of educational and patient decision aids on decisional conflict associated with total knee arthroplasty

University of Texas MD Anderson Cancer Center, Houston, USA.
Arthritis care & research 02/2012; 64(2):229-37. DOI: 10.1002/acr.20646
Source: PubMed

ABSTRACT To examine the impact of a videobooklet patient decision aid supplemented by an interactive values clarification exercise on decisional conflict in patients with knee osteoarthritis (OA) considering total knee arthroplasty.
A total of 208 patients participated in the study (mean age 63 years, 68% female, and 66% white). Participants were randomized to 1 of 3 groups: 1) educational booklet on OA management (control), 2) patient decision aid (videobooklet) on OA management, and 3) patient decision aid (videobooklet) + adaptive conjoint analysis (ACA) tool. The ACA tool enables patients to consider competing attributes (i.e., specific risks/benefits) by asking them to rate a series of paired comparisons. The primary outcome was the decisional conflict scale ranging from 0-100. Differences between groups were analyzed using analysis of variance and Tukey's honestly significant difference tests.
Overall, decisional conflict decreased significantly in all groups (P < 0.05). The largest reduction in decisional conflict was observed for participants in the videobooklet decision aid group (21 points). Statistically significant differences in pre- versus postintervention total scores favored the videobooklet group compared to the control group (21 versus 10) and to the videobooklet plus ACA group (21 versus 14; P < 0.001). Changes in the decisional conflict score for the control group compared to the videobooklet decision aid + ACA group were not significantly different.
In our study, an audiovisual patient decision aid decreased decisional conflict more than printed material alone or the addition of a more complex computer-based ACA tool requiring more intense cognitive involvement and explicit value choices.

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