Patient Decision Aids in Joint Replacement Surgery: A Literature Review and An Opinion Survey of Consultant Orthopaedic Surgeons

Department of Medical Oncology, Northern Centre for Cancer Treatment, Newcastle General Hospital, Newcastle upon Tyne, UK.
Annals of The Royal College of Surgeons of England (Impact Factor: 1.27). 05/2008; 90(3):198-207. DOI: 10.1308/003588408X285748
Source: PubMed

ABSTRACT Patient decision aids could facilitate shared decision-making in joint replacement surgery. However, patient decision aids are not routinely used in this setting.
With a view to developing a patient decision aid for UK hip/knee joint replacement practice, we undertook a systematic search of the literature for evidence on the use of shared decision-making and patient decision aids in orthopaedics, and a national survey of consultant orthopaedic surgeons on the potential acceptability and feasibility of patient decision aids.
We found little published evidence regarding shared decision-making or patient decision aids in orthopaedics. In the survey, 362 of 639 (57%) randomly selected consultant orthopaedic surgeons responded. Respondents appear representative of consultant orthopaedic surgeons in the UK. Of 272 valid responses, 79% (95% CI, 73-85%) thought patient decision aids a good or excellent idea. There was consensus on the potential helpfulness of patient decision aids and core content. A booklet to take home was the preferred medium/practice model.
Despite the increased emphasis on patient involvement in decision-making, there is little evidence in the medical literature relating to shared decision-making or the use of patient decision aids in orthopaedic surgery. Further research in this area of clinical practice is required. Our survey shows that consultant orthopaedic surgeons in the UK are generally positive about the use of patient decision aids for joint replacement surgery. Survey results could inform future development of patient decision aids for joint replacement practice in the UK.

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Available from: Hilary A Llewellyn-Thomas, Sep 27, 2015
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    • "Most studies have explored the experiences of people with OA in relation to their referral for consideration of hip or knee replacement rather than solely on the impact of OA on their lives. Existing literature focuses on primary care physicians’ challenges in managing musculoskeletal conditions [16], tools to define who is a candidate for hip or knee replacement [17] or shared decision-making about proceeding to surgery [18,19]. Literature based on the patient experience has often been gathered through patient satisfaction surveys evaluating the process of care [20]. "
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    ABSTRACT: Patient-centered care ideally considers patient preferences, values and needs. However, it is unclear if policies such as wait time strategies for hip and knee replacement surgery (TJR) are patient-centred as they focus on an isolated episode of care. This paper describes the accounts of people scheduled to undergo TJR, focusing on their experience of (OA) as a chronic disease that has considerable impact on their everyday lives. Semi-structured qualitative interviews were conducted with participants scheduled to undergo TJR who were recruited from the practices of two orthopaedic surgeons. We first used maximum variation and then theoretical sampling based on age, sex and joint replaced. 33 participants (age 38-79 years; 17 female) were included in the analysis. 20 were scheduled for hip replacement and 13 for knee replacement. A constructivist approach to grounded theory guided sampling, data collection and analysis. While a specific hip or knee was the target for surgery, individuals experienced multiple-joint symptoms and comorbidities. Management of their health and daily lives was impacted by these combined experiences. Over time, they struggled to manage symptoms with varying degrees of access to and acceptance of pain medication, which was a source of constant concern. This was a multi-faceted issue with physicians reluctant to prescribe and many patients reluctant to take prescription pain medications due to their side effects. For patients, TJR surgery is an acute intervention in the experience of chronic disease, OA and other comorbidities. While policy has focused on wait time as patient/surgeon decision for surgery to surgery date, the patient's experience does not begin or end with surgery as they struggle to manage their pain. Our findings suggest that further work is needed to align the medical treatment of OA with the current policy emphasis on patient-centeredness. Patient-centred care may require a paradigm shift that is not always evident in current policy and strategies.
    BMC Health Services Research 12/2013; 13(1):531. DOI:10.1186/1472-6963-13-531 · 1.71 Impact Factor
    • "Decision boards are visual aids that helps physicians convey information to patients in an unbiased fashion, and in turn, enables patients to reveal their true preference.2 There is little evidence in the orthopedic literature detailing the effectiveness of decision aids in clinical practice.3 However, there is an increasing interest in these tools as evidenced by a recent survey of 272 orthopedic surgeons in the United Kingdom which found that most surgeons perceived decision aids to be a ‘good idea’ or an ‘excellent idea’ for elective hip and knee replacements.3 "
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    ABSTRACT: Decision aids help physicians convey information to patients and enable patients to be involved in the decision-making process. There is a lack of use of decision aids in the orthopedic literature. The purpose of this study was to develop a decision board to elicit preferences for treatment of displaced femoral neck fractures in patients over 60 years old. We developed a decision board presenting descriptions and potential outcomes and complications of two treatment options, hemiarthroplasty (HA) and internal fixation (IF), for displaced femoral neck fractures. Five orthopedic surgeons evaluated the face and content validity of the decision board and 10 volunteers completed "scope tests" to determine the comprehensibility. We then presented the decision board to 108 study participants faced with the scenario of sustaining a displaced femoral neck fracture. Participants stated their preference for operative procedure and described the reasons for their choices. The decision board achieved good face and content validity. All participants in the scope tests appropriately switched their preference to the other modality when probabilities were altered. Most participants found the decision board easy to understand and helpful in making an informed decision. Also, most participants were satisfied with the amount of information presented and with the use of the decision board as a decision making tool. Sixty-one participants (56%) chose IF as their operative procedure of choice quoting less blood loss, shorter operative time, and less invasiveness as the top factors that contributed to this choice. Participants who preferred HA (44%) did so primarily due to the lower re-operation rate. The decision board is a useful and reliable tool to inform patients about the treatment options for displaced femoral neck fractures. They should be utilized by surgeons to incorporate patients' preferences into the decision-making process.
    Indian Journal of Orthopaedics 03/2012; 46(1):22-8. DOI:10.4103/0019-5413.91631 · 0.64 Impact Factor
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    • "Despite the controversy surrounding hip fracture care, the orthopaedic literature is void of studies eliciting patient's preferences and detailing the effectiveness of decision aids to inform patients of hip fracture management [20]. The purpose of this study was to utilize a decision board to elicit surgical preferences for treatment of displaced femoral neck fractures from patients at risk for sustaining this fracture. "
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    ABSTRACT: The optimal treatment of displaced femoral neck fractures in patients over 60 years is controversial. While much research has focused on the impact of total hip arthroplasty (THA) and hemiarthroplasty (HA) on surgical outcomes, little is known about patient preferences for either alternative. The purpose of this study was to elicit surgical preferences of patients at risk of sustaining hip fracture using a novel decision board. We developed a decision board for the surgical management of displaced femoral neck fractures presenting risks and outcomes of HA and THA. The decision board was presented to 81 elderly patients at risk for developing femoral neck fractures identified from an osteoporosis clinic. The participants were faced with the scenario of sustaining a displaced femoral neck fracture and were asked to state their treatment option preference and rationale for operative procedure. Eighty-five percent (85%) of participants were between the age of 60 and 80 years; 89% were female; 88% were Caucasian; and 49% had some post-secondary education. Ninety-three percent (93%; 95% confidence interval [CI], 87-99%) of participants chose THA as their preferred operative choice. Participants identified several factors important to their decision, including the perception of greater walking distance (63%), less residual pain (29%), less reoperative risk (28%) and lower mortality risk (20%) with THA. Participants who preferred HA (7%; 95% CI, 1-13%) did so for perceived less invasiveness (50%), lower dislocation risk (33%), lower infection risk (33%), and shorter operative time (17%). The overwhelming majority of patients preferred THA to HA for the treatment of a displaced femoral neck fracture when confronted with risks and outcomes of both procedures on a decision board.
    BMC Musculoskeletal Disorders 12/2011; 12(1):289. DOI:10.1186/1471-2474-12-289 · 1.72 Impact Factor
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