Decision Aid Implementation and Patients’ Preferences for Hip and Knee Osteoarthritis Treatment: Insights from the High Value Healthcare Collaborative
Open Access
- 1 January 2020
- journal article
- research article
- Published by Taylor & Francis Ltd in Patient Preference and Adherence
- Vol. ume 14, 23-32
- https://doi.org/10.2147/PPA.S227207
Abstract
Background: Shared decision making (SDM) research has emphasized the role of decision aids (DAs) for helping patients make treatment decisions reflective of their preferences, yet there have been few collaborative multi-institutional efforts to integrate DAs in orthopedic consultations and primary care encounters. Objective: In the context of routine DA implementation for SDM, we investigate which patient-level characteristics are associated with patient preferences for surgery versus medical management before and after exposure to DAs. We explored whether DA implementation in primary care encounters was associated with greater shifts in patients’ treatment preferences after exposure to DAs compared to DA implementation in orthopedic consultations. Design: Retrospective cohort study. Setting: 10 High Value Healthcare Collaborative (HVHC) health systems. Study participants: A total of 495 hip and 1343 adult knee osteoarthritis patients who were exposed to DAs within HVHC systems between July 2012 to June 2015. Results: Nearly 20% of knee patients and 17% of hip patients remained uncertain about their treatment preferences after viewing DAs. Older patients and patients with high pain levels had an increased preference for surgery. Older patients receiving DAs from three HVHC systems that transitioned DA implementation from orthopedics into primary care had lower odds of preferring surgery after DA exposure compared to older patients in seven HVHC systems that only implemented DAs for orthopedic consultations. Conclusion: Patients’ treatment preferences were largely stable over time, highlighting that DAs for SDM largely do not necessarily shift preferences. DAs and SDM processes should be targeted at older adults and patients reporting high pain levels. Initiating treatment conversations in primary versus specialty care settings may also have important implications for engagement of patients in SDM via DAs.Keywords
This publication has 49 references indexed in Scilit:
- ErratumInternational Journal of Clinical Practice, 2012
- Physician, Patient, and Contextual Factors Affecting Treatment Decisions in Older Adults With Cancer and Models of Decision Making: A Literature ReviewOncology Nursing Forum, 2011
- Decision aids for people facing health treatment or screening decisionsPublished by Wiley ,2011
- Impact of educational and patient decision aids on decisional conflict associated with total knee arthroplastyArthritis Care & Research, 2011
- Effects of Viewing an Evidence-Based Video Decision Aid on Patientsʼ Treatment Preferences for Spine SurgerySpine, 2011
- Clinical Characteristics and Outcomes of Medicare Patients Undergoing Total Hip Arthroplasty, 1991-2008JAMA, 2011
- A conceptual framework for interprofessional shared decision making in home care: Protocol for a feasibility studyBMC Health Services Research, 2011
- The Interface of Primary and Oncology Specialty Care: From Diagnosis Through Primary TreatmentJNCI Monographs, 2010
- Older Patientsʼ Unexpressed Concerns About Orthopaedic SurgeryJournal of Bone and Joint Surgery, 2008
- Absolute Cardiovascular Disease Risk and Shared Decision Making in Primary Care: A Randomized Controlled TrialAnnals of Family Medicine, 2008