Little evidence available on shared decision-making for knee arthroplasty
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Published results showed little evidence exists about shared decision-making for patients considering knee arthroplasty, with current research including trials of patient decision aids and providing little information on the impact of the interventions on shared decision-making, care and outcomes.
Daniel L. Riddle, PT, PhD, FAPTA, and colleagues performed a database search for randomized controlled trials that had patients considering knee arthroplasty for management of knee arthritis randomly assigned to undergo intervention that promoted shared decision-making vs. usual care or another active control. Researchers had a pair of independent reviewers select the studies for inclusion, extract data and evaluate risk of bias in each trial.
Among the studies identified in the database search, researchers included six randomized controlled trials, of which all tested the same proprietary decision aids while some added other materials to support shared decision-making. Results showed the trials addressed few key elements of shared decision-making, with none of the trials testing interventions used during the clinical encounter and supporting both patient and surgeon. None of the trials evaluated shared decision-making directly by observing the clinical encounter, researchers found.
Although the selected papers had varied primary outcomes, with some trials using several primary outcomes, the more common outcomes included arriving at an informed decision after the first meeting with a surgeon, receipt of a recommendation for knee arthroplasty within 6 or 12 months of a surgical consult, change in patient knowledge and time from consultation to the patient making a definitive treatment choice, according to results. Researchers noted shared decision-making interventions had a significant impact on reducing decisional conflict, patient self-efficacy with developing questions to ask the surgeon, stage of decision-making after the consult and measure of decision quality and knowledge, as well as surgeon-reported ratings of the appropriateness and number of patient questions.
“Our systematic review of randomized clinical trials of shared decision-making in knee arthroplasty found that interventions do not incorporate key elements of shared decision- making during the clinical encounter. Rather, trials have primarily relied of decision aids that only focus on patient knowledge prior to the clinical encounter,” Riddle told Healio Orthopedics. “Future trials evaluating interventions that incorporate innovative approaches and key shared decision-making elements during the patient/surgeon consultation may translate into improved patient care and outcomes including patient satisfaction.” – by Casey Tingle
Disclosure: Riddle reports no relevant financial disclosures.
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