A Codesigned Patient Decision Aid Supports the Decision Quality of Patients Considering Total Knee Arthroplasty: A Randomized Controlled Trial

Abstract

BACKGROUND: The primary aim of this study was to evaluate the effectiveness of a codesigned patient-facing decision aid compared to standard care alone for patients making a high-quality, informed decision regarding the decision to undergo total knee arthroplasty (TKA). METHODS: A double-blind, randomized controlled trial was undertaken in a multisurgeon public hospital arthroplasty clinic and private clinics of orthopaedic surgeons in Australia. A total of 216 patients were randomized before seeing an orthopaedic surgeon to either receive standard care or a printed decision aid in addition to standard care. The primary outcome was whether patients made a high-quality decision (defined as patients being knowledgeable of TKA outcomes and choosing a goal-concordant treatment) 2 weeks post-consultation. Secondary outcomes included how much the decision aid helped make a decision, satisfaction with the decision, and decisional conflict. RESULTS: At the 2-week follow-up, the primary outcome was provided by 173 (80.1%) participants. Participants receiving the aid were more likely to make a high-quality decision (odds ratio: 3.72, 95% confidence interval [CI]: 1.77 to 7.83, P < 0.001) and had lower associated decisional conflict using the Decisional Conflict Scale (mean difference: -5.7, 95% CI: -10.9 to -0.5, P = 0.033). Participants receiving the decision aid were more likely to report that they felt informed (mean difference: 2.2, 95% CI: 1.3 to 3.1, P < 0.001). There was no difference in the rate of surgery election or short-term satisfaction with the decision-making process. CONCLUSIONS: The decision aid markedly improved the likelihood of a patient making a high-quality decision and had less decisional conflict. Use of the aid in practice was feasible.