What do osteoarthritic patients really think and how do they evaluate critical elements of their care and, ultimately, their decision to undergo a total knee arthroplasty surgery?
A new study has answers which, may, be surprising to most large joint surgeons and their staff.
The study began with 49 members of the Arthritis Power CreakyJoints program who agreed to answer questions as part of a focus group. From there, researchers developed an online patient survey about decision making and information needs related to total knee arthroplasty (TKA), and then asked 574 members of CreakyJoints and ArthritisPower to complete it.
The survery results? Osteoarthritis (OA) patients don’t think they have enough information to make important decisions about their surgeon, device type, surgical approach, facility, or timing of a total knee arthroplasty surgery.
The resulting paper, “Identifying patient decisions and related information needs during decision making related to total knee arthroplasty,” appears in the October 30, 2020 edition of the Journal of Comparative Effectiness Research.
W. Benjamin Nowell, Ph.D., M.S.W., director of Patient-Centered Research, at the Global Health Living Foundation in Nyack, New York, director of CreakyJoints and Principal Investigator of the ArthritisPower research registry and study co-author told OTW, “Beyond the decision to undergo total knee arthroplasty (TKA), there are a number of subsequent decisions that are important from the patient perspective, including choice of surgeon, implant device, surgical approach, facility, and timing. Patients who are candidates for the procedure feel that the information available to them about critical choices is inadequate, especially when it comes to the selection of implant device and surgical approach.”
Dr. Nowell and his team gathered data using a number of mixed methods. “First we conducted online focus groups to identify arthroplasty-related decisions that were important to joint replacement patients. Then we administered a survey to a much larger sample to find out which of the decisions identified in focus groups mattered most to TKA patients, and the extent to which information was perceived as available to make those decisions.”
“The survey was completed by 574 ArthritisPower research registry participants with arthritis of the knee (osteoarthritis, rheumatoid arthritis or psoriatic arthritis) who were at least 50 years old, and had not had a joint replacement surgery. Survey participants ranked the decisions they felt would be most important to them once they decide to undergo TKA.”
“Choice of surgeon was most important, followed by choice of device and approach. The facility or clinical site for the procedure and timing of surgery were ranked fourth and fifth. Patients seemed to realize that their choice of surgeon was primary and likely to steer subsequent decisions about surgical approach, implant device and the clinical site for the procedure. Nevertheless, it was notable that 85-90% of patients did not feel they had adequate information about the choice of device and surgical approach.”
Given these survey results, Dr. Nowell is looking ahead at the next phase of this important research. “The next steps for research in this area will be to determine the information presentation format or decision aids that resonate best with patients. We also think health systems, payors, and providers should improve how they communicate information to patients about the decisions that affect them, such as implant device selection.”
“Patients in our study identified that they would like more visibility into such decisions. Even if patients themselves aren’t the ones primarily choosing a device, for example, they want to understand how their surgeon is making the call about what is best for them.”
“On the patient side, there is a need to curate information and develop decision aids that are accessible to them. At CreakyJoints, we created the Raising the Voice of the Patient guides, adapting clinical guidelines into patient-friendly language that describes treatment options and offers evidence-based recommendations. Data show that preoperative patient education may reduce anxiety, help establish realistic expectations and improve joint replacement outcomes.”
