• Orthopaedic Procedures
• Orthopaedics Clinical Trials

• Orthopaedics
• Orthopaedic Procedures
• Orthopaedics Clinical Trials

Kevin J Bozic, MD, MBA, University of California, San Francisco, San Francisco, California, USA, presented data from a randomized controlled trial (RCT), demonstrating that more patients made informed treatment decisions during their first appointment with an orthopedic surgeon if shared decision-making (SDM) interventions were used [Bozic KJ et al. J Bone Joint Surg Am 2013].

Although the concept of SDM is an important philosophy that has been shown to be effective in clinical practice, the use of tools for treatment decisions to enhance decision quality and patient engagement has not yet been widely adopted in orthopedic practice.

Consequently, Dr. Bozic and colleagues designed a RCT in patients with osteoarthritis (OA) of the hip or knee to assess the impact of decision and communication aids on patient knowledge, decision-making efficiency, treatment choice, and patient and surgeon experience.

Patients who were appropriate candidates for hip or knee replacement (n=123) were included in the study and randomized to a SDM intervention group (IG; n=61), or usual care (UC; n=62). Those in the IG received a combination of aids to enhance patient knowledge, question asking and information recall. Their decision aid was a DVD and booklet detailing the natural history and treatment alternatives for OA of the hip and knee, and comparing the risks and benefits of surgical and nonsurgical options. They also received a telephone consultation with a trained health coach to help them formulate a list of questions for their surgeon into an organized one-page document. Patients in the control group received information in the mail about the surgeon's practice.

Inclusion criteria included a primary diagnosis of OA of the hip or knee, first visit with an orthopedic surgeon for this problem, and no history of a lower-extremity joint arthroplasty. Patients were excluded if they could not read or speak English, or had previously visited another orthopedic surgeon for evaluation of the problem.

The primary outcome was whether patients reached an informed decision during their first appointment. Secondary outcomes included treatment choice, patient and provider satisfaction, and length of appointment time. Ultimately, 61 individuals in the IG, and 62 individuals in the UC group were included in the data analysis.

The results demonstrated that significantly more patients in the IG reached an informed decision during their first orthopedic appointment compared with those in the UC group (58.3% vs 33.3%; p=0.01; Table 1). Additionally, patients in the IG were more confident that they knew what questions to ask their surgeon during the visit (p=0.0034). Following the appointment, there was no significant difference between groups in their treatment choice (eg, surgical or nonsurgical; p=0.48).

Surgeons also experienced benefits associated with SDM. With respect to the IG, they reported being asked more appropriate questions by patients (p<0.0001), increased satisfaction with the efficiency of the visits (p<0.0001), and increased overall satisfaction with the patient encounter (p<0.0001).

Dr. Bozic and colleagues concluded that the results of their study demonstrate that SDM interventions in orthopedic practice benefit both the patient and surgeon, and he emphasized the value of introducing decision and communication aids into routine orthopedic practice.

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