Impact of educational and patient decision aids on decisional conflict associated with total knee arthroplasty




To examine the impact of a videobooklet patient decision aid supplemented by an interactive values clarification exercise on decisional conflict in patients with knee osteoarthritis (OA) considering total knee arthroplasty.


A total of 208 patients participated in the study (mean age 63 years, 68% female, and 66% white). Participants were randomized to 1 of 3 groups: 1) educational booklet on OA management (control), 2) patient decision aid (videobooklet) on OA management, and 3) patient decision aid (videobooklet) + adaptive conjoint analysis (ACA) tool. The ACA tool enables patients to consider competing attributes (i.e., specific risks/benefits) by asking them to rate a series of paired comparisons. The primary outcome was the decisional conflict scale ranging from 0–100. Differences between groups were analyzed using analysis of variance and Tukey's honestly significant difference tests.


Overall, decisional conflict decreased significantly in all groups (P < 0.05). The largest reduction in decisional conflict was observed for participants in the videobooklet decision aid group (21 points). Statistically significant differences in pre- versus postintervention total scores favored the videobooklet group compared to the control group (21 versus 10) and to the videobooklet plus ACA group (21 versus 14; P < 0.001). Changes in the decisional conflict score for the control group compared to the videobooklet decision aid + ACA group were not significantly different.


In our study, an audiovisual patient decision aid decreased decisional conflict more than printed material alone or the addition of a more complex computer-based ACA tool requiring more intense cognitive involvement and explicit value choices.