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Scientific Articles   |    
Shared Decision Making in Patients with Osteoarthritis of the Hip and KneeResults of a Randomized Controlled Trial
Kevin J. Bozic, MD, MBA1; Jeffrey Belkora, PhD2; Vanessa Chan, MPH1; Jiwon Youm, MD, MS1; Tianzan Zhou, BS3; John Dupaix, MD4; Angela Nava Bye, MA, ATC5; Clarence H. Braddock, III, MD, MPH6; Kate Eresian Chenok, MBA7; James I. Huddleston, III, MD5
1 Department of Orthopaedic Surgery, University of California, San Francisco, 500 Parnassus Avenue, MU 320W, San Francisco, CA 94143-0728. E-mail address for K.J. Bozic: kevin.bozic@ucsf.edu
2 Philip R. Lee Institute for Health Policy Studies, University of California, San Francisco, 3333 California Street, Suite 265, San Francisco, CA 94143-0936
3 San Diego School of Medicine, University of California, San Diego, 9500 Gilman Drive, La Jolla, CA 92093
4 Department of Orthopaedic Surgery, University of Hawaii, 1356 Lusitana Street, Room 613, Honolulu, HI 96813
5 Department of Orthopaedic Surgery, Stanford University Medical Center, 450 Broadway Street, M/C 3142, Redwood City, CA 94063
6 Stanford Center for Medical Research and Innovation, 1265 Welch Road, MSOB X333, MC5404, Stanford, CA 94305-5404
7 Pacific Business Group on Health, 221 Main Street, Suite 1500, San Francisco, CA 94105
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  • Disclosure statement for author(s): PDF

Investigation performed at the University of California, San Francisco, San Francisco, California, and Stanford University Medical Center, Stanford, California

A commentary by Terence J. Gioe, MD, is linked to the online version of this article at jbjs.org.



Disclosure: One or more of the authors received payments or services, either directly or indirectly (i.e., via his or her institution), from a third party in support of an aspect of this work. In addition, one or more of the authors, or his or her institution, has had a financial relationship, in the thirty-six months prior to submission of this work, with an entity in the biomedical arena that could be perceived to influence or have the potential to influence what is written in this work. No author has had any other relationships, or has engaged in any other activities, that could be perceived to influence or have the potential to influence what is written in this work. The complete Disclosures of Potential Conflicts of Interest submitted by authors are always provided with the online version of the article.

Copyright © 2013 by The Journal of Bone and Joint Surgery, Inc.
J Bone Joint Surg Am, 2013 Sep 18;95(18):1633-1639. doi: 10.2106/JBJS.M.00004
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Abstract

Background: 

Despite evidence that shared decision-making tools for treatment decisions improve decision quality and patient engagement, they are not commonly employed in orthopaedic practice. The purpose of this study was to evaluate the impact of decision and communication aids on patient knowledge, efficiency of decision making, treatment choice, and patient and surgeon experience in patients with osteoarthritis of the hip or knee.

Methods: 

One hundred and twenty-three patients who were considered medically appropriate for hip or knee replacement were randomized to either a shared decision-making intervention or usual care. Patients in the intervention group received a digital video disc and booklet describing the natural history and treatment alternatives for hip and knee osteoarthritis and developed a structured list of questions for their surgeon in consultation with a health coach. Patients in the control group received information about the surgeon’s practice. Both groups reported their knowledge and stage in decision making and their treatment choice, satisfaction, and communication with their surgeon. Surgeons reported the appropriateness of patient questions and their satisfaction with the visit. The primary outcome measure tracked whether patients reached an informed decision during their first visit. Statistical analyses were performed to evaluate differences between groups.

Results: 

Significantly more patients in the intervention group (58%) reached an informed decision during the first visit compared with the control group (33%) (p = 0.005). The intervention group reported higher confidence in knowing what questions to ask their doctor (p = 0.0034). After the appointment, there was no significant difference between groups in the percentage of patients choosing surgery (p = 0.48). Surgeons rated the number and appropriateness of patient questions higher in the intervention group (p < 0.0001), reported higher satisfaction with the efficiency of the intervention group visits (p < 0.0001), and were more satisfied overall with the intervention group visits (p < 0.0001).

Conclusions: 

Decision and communication aids used in orthopaedic practice had benefits for both patients and surgeons. These findings could be important in facilitating adoption of shared decision-making tools into routine orthopaedic practice.

Level of Evidence: 

Therapeutic Level I. See Instructions for Authors for a complete description of levels of evidence.

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    References

    Accreditation Statement
    These activities have been planned and implemented in accordance with the Essential Areas and policies of the Accreditation Council for Continuing Medical Education (ACCME) through the joint sponsorship of the American Academy of Orthopaedic Surgeons and The Journal of Bone and Joint Surgery, Inc. The American Academy of Orthopaedic Surgeons is accredited by the ACCME to provide continuing medical education for physicians.
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