Impact of educational and patient decision aids on decisional conflict associated with total knee arthroplasty
Article first published online: 25 JAN 2012
Copyright © 2012 by the American College of Rheumatology
Arthritis Care & Research
Volume 64, Issue 2, pages 229–237, February 2012
How to Cite
de Achaval, S., Fraenkel, L., Volk, R. J., Cox, V. and Suarez-Almazor, M. E. (2012), Impact of educational and patient decision aids on decisional conflict associated with total knee arthroplasty. Arthritis Care Res, 64: 229–237. doi: 10.1002/acr.20646
- Issue published online: 25 JAN 2012
- Article first published online: 25 JAN 2012
- Accepted manuscript online: 27 SEP 2011 10:31AM EST
- Manuscript Accepted: 12 SEP 2011
- Manuscript Received: 5 JUL 2011
- Agency for Healthcare Research and Quality through the Center for Education and Research on Therapeutics. Grant Number: U18-HS016093
- NIH/National Institute of Arthritis and Musculoskeletal and Skin Diseases K23 award. Grant Number: AR-048826-05
- K24 career award from the National Institute of Arthritis and Musculoskeletal and Skin Diseases. Grant Number: AR-53593-06
- Agency for Healthcare Research and Quality
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.