Osteoarthritis
Conditions
Keywords
Patient decision aids, Patient preferences, Osteoarthritis, Joint replacement, Waiting times
Brief summary
Ministries of Health consider wait lists for total joint replacement a top priority. Research priorities to manage wait lists indicate the need to establish benchmarks that consider patient preferences. However, patients' preferences for hip or knee replacements are strongly associated with their misperceptions of the indicators for, and the risks and benefits of, these procedures. These misperceptions can be corrected with the use of patient decision aids. When decision aids are used in combination with assessing surgical eligibility, there may be a reduction in unnecessary referrals for surgery either because the patient is ineligible or because the eligible candidates make informed decisions to forgo this option. The primary study objective is to evaluate the effect of patient decision aids (PtDAs) on total wait times (wait times for surgical consultation, plus wait times for surgery) when used in combination with a general practitioner run clinic to screen patients with hip or knee osteoarthritis for surgical eligibility. Major secondary objectives include determining (a) the effect of PtDAs on surgery rates within two years, (b) the effect of PtDAs on decision quality, and (c) cost-effectiveness of PtDAs for total joint arthroplasty.
Detailed description
This was not indicated as required.
Interventions
BEHAVIORALPatient decision aid
Patients will receive i) Patient education:usual take home education brochure from recruiting hospital ii)a video/DVD PtDA for either hip (Treatment choices for hip osteoarthritis) or knee (Treatment choices for knee osteoarthritis) © Health Dialog 2005. iii) a personal decision form:an interactive form used by patients after the DVD to elicit their knowledge, values, preferred option, and perceptions of the decision making process. iv) Referred onward to the surgeon with their preferences for surgery using a standardized report of their clinical findings plus decisional data (knowledge, values, preference).
BEHAVIORALUsual care
Patients will receive i) the usual take-home educational brochure available at the recruiting hospital describing preparation for surgery after the decision is made, recovery after surgery, and discharge plans. ii) Referral onward to surgeon with a standardized report of clinical findings only
Sponsors
Foundation for Informed Medical Decision Making
The Ottawa Hospital
Queensway Carleton Hospital
University of Ottawa
University of Toronto
University of Chicago
Northwestern University Feinberg School of Medicine
Northwestern University
Dartmouth-Hitchcock Medical Center
Ottawa Hospital Research Institute
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
HEALTH_SERVICES_RESEARCH
Masking
SINGLE (Outcomes Assessor)
Eligibility
Sex/Gender
ALL
Healthy volunteers
No
Inclusion criteria
* Patients referred for surgical consultation for hip or knee osteoarthritis * WOMAC and HKPT scores indicate that pain and functional criteria are rated as moderate or severe, or there is radiographic evidence of joint damage
Exclusion criteria
* Patients with inflammatory arthritis * Patients who have had previous TJA * Patients unable to understand video/DVD decision aids due to deafness, blindness, cognitive impairment, or language barrier
Design outcomes
Primary
| Measure | Time frame |
|---|---|
| Total wait time for surgery | September 2010 |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Surgery rates determined by the proportion of patients who proceed to surgery within 2 years | January 2012 | — |
| Decision quality, the extent to which patients decisions are informed and values-based | September 2010 | — |
| Cost effectiveness (including estimated effects on quality adjusted life expectancy and costs) | December 2017 | This phase was delayed to have 5 years of follow-up data on all participants |
Countries
Canada
Outcome results
None listed