Research Appraisals

Acta orthopaedica

Effect of an in-consult patient decision aid on decisional quality and involvement for patients with severe hip or knee osteoarthritis: a multicenter, cluster randomized controlled trial

BACKGROUND AND PURPOSE: Shared decision-making (SDM) is important in managing patients with severe hip and knee osteoarthritis, where treatment decisions often depend on patient preferences and values. We aimed to evaluate the effectiveness of an in-consult patient decision aid in improving decision quality and patient involvement compared with usual care. METHODS: In a cluster-randomized controlled trial, surgeons from 2 Danish orthopedic departments were randomized to use in-consult patient decision aids or provide usual care. The primary outcome was decision quality assessed using the Hip/Knee OA Decision Quality Instrument (HK-DQI). Patients who were well informed and received their preferred treatment received an Informed Patient-Centered (IPC) score of 1, indicating good decisional quality; all others scored 0. Secondary outcomes included patient-experienced engagement and involvement in decision-making, assessed using CollaboRATE and the decision-process domain of the Hip/Knee OA Decision Quality Instrument and consultation duration. Relative risks (RR) and mean differences (MD) with 95% confidence intervals (CIs) were estimated using multilevel regression models. RESULTS: 20 surgeons were randomized to either use in-consult patient decision aids (n = 10) or provide usual care (n = 10). Of the 1,038 patients screened for severe hip or knee osteoarthritis, 581 were included in the study. Decision quality was similar between groups, with a score of 43 (36-51) in the intervention group and 44 (37-52) in the usual care group (RR 0.9, CI 0.7-1.2; P = 0.8), likewise, patient-experienced engagement assessed with CollaboRATE (RR 1.1, CI 0.8-1.4; P = 0.6). Consultations were longer in the intervention group, with a mean difference of 3.9 minutes (CI 0.1-7.7; P = 0.04). CONCLUSION: Decision quality and patient-reported engagement were similar between groups, while consultation time was longer with in-consult patient decision aids use. In the absence of prespecified minimal important differences, the clinical relevance of these findings remains uncertain.