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Factors associated with the quality of patients' surgical decisions for treatment of hip and knee osteoarthritis.

Abstract：

BACKGROUND:Shared decision making requires informing patients and ensuring that treatment decisions reflect their goals. It is not clear to what extent this happens for patients considering total joint replacement (TJR) for hip or knee osteoarthritis. STUDY DESIGN:We conducted a cross-sectional mail survey of osteoarthritis patients at 4 sites, who made a decision about TJR. The survey measured knowledge and goals, the decision making process, decision confidence, and decision regret. Decision quality was defined as the percentage of patients who had high knowledge scores and received treatments that matched their goals. Multivariable regression models examined factors associated with knowledge and decision quality. RESULTS:There were 382 patients who participated (78.6% response rate). Mean knowledge score was 61% (SD 20.7%). In multivariate linear regression, higher education, having TJR, and site were associated with higher knowledge. Many patients (73%) received treatments that matched their goals. Thirty-one percent of patients met our definition for high decision quality. Higher decision making process scores, higher quality of life scores, and site were associated with higher decision quality. Patients who had high decision quality had less regret (73.1% vs 58.5%, p = 0.007) and greater confidence (9.0 [SD 1.6] vs 8.2 [SD 2.3] out of 10, p < 0.001). CONCLUSIONS:A third of patients who recently made a decision about osteoarthritis treatment met both criteria for a high quality decision. Controlling for treatment, patients reporting more involvement in the decision making process, higher quality of life, and being seen at a site that uses decision aids were associated with higher decision quality.

journal_name

J Am Coll Surg

journal_title

Journal of the American College of Surgeons

authors

Sepucha K,Feibelmann S,Chang Y,Clay CF,Kearing SA,Tomek I,Yang T,Katz JN

doi

10.1016/j.jamcollsurg.2013.06.002

subject

Has Abstract

pub_date

2013-10-01 00:00:00

pages

694-701

issue

eissn

1072-7515

issn

1879-1190

pii

S1072-7515(13)00439-0

journal_volume

217

pub_type

杂志文章

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Factors associated with the quality of patients' surgical decisions for treatment of hip and knee osteoarthritis.