Randomized Controlled Trial
Copyright ©The Author(s) 2021. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Orthop. Dec 18, 2021; 12(12): 1026-1035
Published online Dec 18, 2021. doi: 10.5312/wjo.v12.i12.1026
Decision aids can decrease decisional conflict in patients with hip or knee osteoarthritis: Randomized controlled trial
Lode A van Dijk, Antonius MJS Vervest, Dominique C Baas, Rudolf W Poolman, Daniel Haverkamp
Lode A van Dijk, Antonius MJS Vervest, Dominique C Baas, Department of Orthopedic Surgery, Tergooi Hospital, Hilversum 1213 XZ, Noord-Holland, Netherlands
Rudolf W Poolman, Department of Orthopedic Surgery, Onze Lieve Vrouwe Gasthuis, Amsterdam 1091 AC, Netherlands
Rudolf W Poolman, Department of Orthopedic Surgery, Leiden University Medical Centre, Leiden 2333 ZA, Netherlands
Daniel Haverkamp, Department of Orthopedic Surgery, Xpert Orthopedie Amsterdam/SCORE (Specialized Center of Orthopedic Research and Education), Amsterdam 1101 EA, Netherlands
Author contributions: Poolman RW and Haverkamp D contributed to the study design; Poolman RW, Haverkamp D and Vervest AMSJ contributed to including patients in the study; van Dijk LA, Vervest AMSJ and Baas DC wrote the first draft of the manuscript; all authors read and approved the final manuscript before submission.
Institutional review board statement: The study was reviewed and approved by the Medical Ethics Committee of Slotervaart Hospital. The METC number is P1263.
Clinical trial registration statement: This study is registered at Nederlands Trial Register. The registration identification number is NL4291 (Old trial number: NTR4435).
Informed consent statement: No additional invasive diagnostic interventions or invasive treatments were performed. For this study a waiver for informed consent was obtained.
Conflict-of-interest statement: There is no conflict-of-interest.
Data sharing statement: No additional data are available.
CONSORT 2010 statement: The authors have read the CONSORT 2010 Statement, and the manuscript was prepared and revised according to the CONSORT 2010 Statement.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Lode A van Dijk, MD, N/A, Department of Orthopedic Surgery, Tergooi Hospital, van Riebeeckweg 212, Hilversum 1213 XZ, Noord-Holland, Netherlands. lvandijk@tergooi.nl
Received: March 20, 2021
Peer-review started: March 20, 2021
First decision: June 7, 2021
Revised: June 21, 2021
Accepted: November 24, 2021
Article in press: November 24, 2021
Published online: December 18, 2021
Processing time: 268 Days and 16.5 Hours
Abstract
BACKGROUND

The interest in shared decision making has increased considerably over the last couple of decades. Decision aids (DAs) can help in shared decision making. Especially when there is more than one reasonable option and outcomes between treatments are comparable.

AIM

To investigate if the use of DAs decreases decisional conflict in patients when choosing treatment for knee or hip osteoarthritis (OA).

METHODS

In this multi-center unblinded randomized controlled trial of patients with knee or hip OA were included from four secondary and tertiary referral centers. One-hundred-thirty-one patients who consulted an orthopedic surgeon for the first time with knee or hip OA were included between December 2014 and January 2016. After the first consultation, patients were randomly assigned by a computer to the control group which was treated according to standard care, or to the intervention group which was treated with standard care and provided with a DA. After the first consultation, patients were asked to complete questionnaires about decisional conflict (DCS), satisfaction, anxiety (PASS-20), gained knowledge, stage of decision making and preferred treatment. Follow-up was carried out after 26 wk and evaluated decisional conflict, satisfaction, anxiety, health outcomes (HOOS/KOOS), quality of life (EQ5D) and chosen treatment.

RESULTS

After the first consultation, patients in the intervention group (mean DCS: 25 out of 100, SD: 13) had significantly (P value: 0.00) less decisional conflict compared to patients in the control group (mean DCS: 39 out of 100, SD 11). The mean satisfaction score for the given information (7.6 out of 10, SD: 1.8 vs 8.6 out of 10, SD: 1.1) (P value: 0.00), mean satisfaction score with the physician (8.3 out of 10, SD: 1.7 vs 8.9 out of 10, SD: 0.9) (P value: 0.01) and the mean knowledge score (3.3 out of 4, SD: 0.9 vs 3.7 out of, SD: 0.6) (P value: 0.01) were all significantly higher in the intervention group. At 26-wk follow-up, only 75 of 131 patients (57%) were available for analysis. This sample is too small for meaningful analysis.

CONCLUSION

Providing patients with an additional DA may have a positive effect on decisional conflict after the first consultation. Due to loss to follow-up we are unsure if this effect remains over time.

Keywords: Decision aid, Decisional conflict, Shared decision making, Anxiety, Hip osteoarthritis, Knee osteoarthritis

Core Tip: Patients with knee or hip osteoarthritis provided with an additional decision aid appear to have less decisional conflict, more knowledge about their treatment, more satisfaction with the given information by their physician and therefore more satisfaction with their physician after their first consultation with the physician.