scholarly journals Impact of educational and patient decision aids on decisional conflict associated with total knee arthroplasty

2012 ◽  
Vol 64 (2) ◽  
pp. 229-237 ◽  
Author(s):  
Sofia de Achaval ◽  
Liana Fraenkel ◽  
Robert J. Volk ◽  
Vanessa Cox ◽  
Maria E. Suarez-Almazor
Keyword(s):  
Total Knee Arthroplasty ◽  
Knee Arthroplasty ◽  
Decision Aids ◽  
Decisional Conflict ◽  
Patient Decision Aids ◽  
Patient Decision ◽  
Total Knee

scholarly journals Protocol for systematic review: patient decision aids for total hip and knee arthroplasty decision-making

2021 ◽  
Vol 10 (1) ◽  
Author(s):  
Lissa Pacheco-Brousseau ◽  
Marylène Charette ◽  
Dawn Stacey ◽  
Stéphane Poitras
Keyword(s):  
Systematic Review ◽  
Decision Making ◽  
Knee Arthroplasty ◽  
Patient Involvement ◽  
Decision Aids ◽  
Risk Of Bias ◽  
Decision Making Process ◽  
Patient Decision Aids ◽  
Patient Decision ◽  
Hip And Knee Arthroplasty

Abstract Background Total hip and knee arthroplasty are a highly performed surgery; however, patient satisfaction with surgery results and patient involvement in the decision-making process remains low. Patient decision aids (PtDAs) are tools used in clinical practices to facilitate active patient involvement in healthcare decision-making. Nonetheless, PtDA effects have not been systematically evaluated for hip and knee total joint arthroplasty (TJA) decision-making. The aim of this systematic review is to determine the effect of patient decision aids compared to alternative of care on quality and process of decision-making when provided to adults with hip and knee osteoarthritis considering primary elective TJA. Methods This systematic review will follow the Cochrane Handbook for Systematic Reviews. This protocol was reported based on the PRISMA-P checklist guidelines. Studies will be searched in CINAHL, MEDLINE, Embase, PsycINFO, and Web of Science. Eligible studies will be randomized control trial (RCT) evaluating the effect of PtDA on TJA decision-making. Descriptive and meta-analysis of outcomes will include decision quality (knowledge and values-based choice), decisional conflict, patient involvement, decision-making process satisfaction, actual decision made, health outcomes, and harm(s). Risk of bias will be evaluated with Cochrane’s risk of bias tool for RCTs. Quality and strength of recommendations will be appraised with Grades of Recommendation, Assessment, Development and Evaluation (GRADE). Discussion This review will provide a summary of RCT findings on PtDA effect on decision-making quality and process of adults with knee and hip osteoarthritis considering primary elective TJA. Further, it will provide evidence comparing different types of PtDA used for TJA decision-making. This review is expected to inform further research on joint replacement decision-making quality and processes and on ways PtDAs facilitate shared decision-making for orthopedic surgery. Systematic review registration PROSPERO CRD42020171334

scholarly journals Barriers and facilitators to orthopaedic surgeons’ uptake of decision aids for total knee arthroplasty: a qualitative study

BMJ Open ◽  
2017 ◽  
Vol 7 (11) ◽  
pp. e018614 ◽  
Author(s):  
Samantha Bunzli ◽  
Elizabeth Nelson ◽  
Anthony Scott ◽  
Simon French ◽  
Peter Choong ◽  
...  
Keyword(s):  
Total Knee Arthroplasty ◽  
Qualitative Study ◽  
Knee Arthroplasty ◽  
Decision Aid ◽  
Decision Aids ◽  
Theoretical Domains Framework ◽  
Barriers And Facilitators ◽  
Meaningful Improvement ◽  
Orthopaedic Surgeons ◽  
Total Knee

ObjectivesThe demand for total knee arthroplasty (TKA) is increasing. Differentiating who will derive a clinically meaningful improvement from TKA from others is a key challenge for orthopaedic surgeons. Decision aids can help surgeons select appropriate candidates for surgery, but their uptake has been low. The aim of this study was to explore the barriers and facilitators to decision aid uptake among orthopaedic surgeons.DesignA qualitative study involving face-to-face interviews. Questions were constructed on the Theoretical Domains Framework to systematically explore barriers and facilitators.SettingOne tertiary hospital in Australia.ParticipantsTwenty orthopaedic surgeons performing TKA.Outcome measuresBeliefs underlying similar interview responses were identified and grouped together as themes describing relevant barriers and facilitators to uptake of decision aids.ResultsWhile prioritising their clinical acumen, surgeons believed a decision aid could enhance communication and patient informed consent. Barriers identified included the perception that one’s patient outcomes were already optimal; a perceived lack of non-operative alternatives for the management of end-stage osteoarthritis, concerns about mandatory cut-offs for patient-centred care and concerns about the medicolegal implications of using a decision aid.ConclusionsMultifaceted implementation interventions are required to ensure that orthopaedic surgeons are ready, willing and able to use a TKA decision aid. Audit/feedback to address current decision-making biases such as overconfidence may enhance readiness to uptake. Policy changes and/or incentives may enhance willingness to uptake. Finally, the design/implementation of effective non-operative treatments may enhance ability to uptake by ensuring that surgeons have the resources they need to carry out decisions.

scholarly journals Clarifying Values: An Updated and Expanded Systematic Review and Meta-Analysis

2021 ◽  
Author(s):  
Holly O. Witteman ◽  
Ruth Ndjaboue ◽  
Gratianne Vaisson ◽  
Selma Chipenda Dansokho ◽  
Bob Arnold ◽  
...  
Keyword(s):  
Decision Analysis ◽  
Decision Aids ◽  
Decisional Conflict ◽  
Multicriteria Decision Analysis ◽  
Values Clarification ◽  
Patient Decision Aids ◽  
Multicriteria Decision ◽  
Patient Decision ◽  
Chi Squared ◽  
Decisional Regret

AbstractBackgroundPatient decision aids should help people make evidence-informed decisions aligned with their values. There is limited guidance about how to achieve such alignment.PurposeTo describe the range of values clarification methods available to patient decision aid developers, synthesize evidence regarding their relative merits, and foster collection of evidence by offering researchers a proposed set of outcomes to report when evaluating the effects of values clarification methods.Data SourcesMEDLINE, EMBASE, PubMed, Web of Science, the Cochrane Library, CINAHLStudy SelectionWe included articles that described randomized trials of one or more explicit values clarification methods. From 30,648 records screened, we identified 33 articles describing trials of 43 values clarification methods.Data ExtractionTwo independent reviewers extracted details about each values clarification method and its evaluation.Data SynthesisCompared to control conditions or to implicit values clarification methods, explicit values clarification methods decreased the frequency of values-disgruent choices (risk difference -0.04 95% CI [-0.06 to -0.02], p<.001) and decisional regret (standardized mean difference -0.20 95% CI [-0.29 to -0.11], p<0.001). Multicriteria decision analysis led to more values-congruent decisions than other values clarification methods (Chi-squared(2)=9.25, p=.01). There were no differences between different values clarification methods regarding decisional conflict (Chi-squared(2)=6.08, p=.05).LimitationsSome meta-analyses had high heterogeneity. We grouped values clarification methods into broad categories.ConclusionsCurrent evidence suggests patient decision aids should include an explicit values clarification method. Developers may wish to specifically consider multicriteria decision analysis. Future evaluations of values clarification methods should report their effects on decisional conflict, decisions made, values congruence, and decisional regret.

scholarly journals Go to the Hospital or Stay Here?: A Randomized Clinical Trial

2020 ◽  
Vol 4 (Supplement_1) ◽  
pp. 760-760
Author(s):  
Sarah Worch ◽  
Ruth Tappen
Keyword(s):  
Clinical Trial ◽  
Decision Aid ◽  
Long Term Care ◽  
Decision Aids ◽  
Decisional Conflict ◽  
Term Care ◽  
Patient Decision Aids ◽  
Patient Decision ◽  
Initial Clinical Trial

Abstract With the exception of guides for making end of life choices, there are very few if any patient decision aids created for residents of long-term care facilities. Further, only half of patient decision aids produced for any purpose have actually been field tested with patients and even fewer have been evaluated by providers other than the developers of the decision aid. Development of Go to the Hospital or Stay Here? was based on expert experience combined with extensive input from over 270 long-term care residents, their families and their caregivers. The initial clinical trial of this decision aid is reported in this presentation. Increased knowledge, reduced decisional conflict, increased preference for care in the nursing home when possible and a high rating of the helpfulness of the Guide were found in those who received the Guide (n=97) compared to those who did not (n=95).

scholarly journals Clarifying Values: An Updated and Expanded Systematic Review and Meta-Analysis

2021 ◽  
Vol 41 (7) ◽  
pp. 801-820
Author(s):  
Holly O. Witteman ◽  
Ruth Ndjaboue ◽  
Gratianne Vaisson ◽  
Selma Chipenda Dansokho ◽  
Bob Arnold ◽  
...  
Keyword(s):  
Decision Analysis ◽  
Decision Aids ◽  
Decisional Conflict ◽  
Multicriteria Decision Analysis ◽  
Current Evidence ◽  
Cochrane Library ◽  
Values Clarification ◽  
Patient Decision Aids ◽  
Multicriteria Decision ◽  
Patient Decision

Background Patient decision aids should help people make evidence-informed decisions aligned with their values. There is limited guidance about how to achieve such alignment. Purpose To describe the range of values clarification methods available to patient decision aid developers, synthesize evidence regarding their relative merits, and foster collection of evidence by offering researchers a proposed set of outcomes to report when evaluating the effects of values clarification methods. Data Sources MEDLINE, EMBASE, PubMed, Web of Science, the Cochrane Library, and CINAHL. Study Selection We included articles that described randomized trials of 1 or more explicit values clarification methods. From 30,648 records screened, we identified 33 articles describing trials of 43 values clarification methods. Data Extraction Two independent reviewers extracted details about each values clarification method and its evaluation. Data Synthesis Compared to control conditions or to implicit values clarification methods, explicit values clarification methods decreased the frequency of values-incongruent choices (risk difference, –0.04; 95% confidence interval [CI], –0.06 to –0.02; P < 0.001) and decisional conflict (standardized mean difference, –0.20; 95% CI, –0.29 to –0.11; P < 0.001). Multicriteria decision analysis led to more values-congruent decisions than other values clarification methods (χ2 = 9.25, P = 0.01). There were no differences between different values clarification methods regarding decisional conflict (χ2 = 6.08, P = 0.05). Limitations Some meta-analyses had high heterogeneity. We grouped values clarification methods into broad categories. Conclusions Current evidence suggests patient decision aids should include an explicit values clarification method. Developers may wish to specifically consider multicriteria decision analysis. Future evaluations of values clarification methods should report their effects on decisional conflict, decisions made, values congruence, and decisional regret.

scholarly journals Do Personal Stories Make Patient Decision Aids More Effective? An Update from the International Patient Decision Aids Standards

2021 ◽  
pp. 0272989X2110111
Author(s):  
Victoria A. Shaffer ◽  
Suzanne Brodney ◽  
Teresa Gavaruzzi ◽  
Yaara Zisman Ilani ◽  
Sarah Munro ◽  
...  
Keyword(s):  
Decision Aids ◽  
Relevant Literature ◽  
Empirical Work ◽  
Theoretical Work ◽  
Decisional Conflict ◽  
Bottom Line ◽  
Patient Decision Aids ◽  
Patient Narratives ◽  
Patient Decision ◽  
The Impact

Background This article evaluates the evidence for the inclusion of patient narratives in patient decision aids (PtDAs). We define patient narratives as stories, testimonials, or anecdotes that provide illustrative examples of the experiences of others that are relevant to the decision at hand. Method To evaluate the evidence for the effectiveness of narratives in PtDAs, we conducted a narrative scoping review of the literature from January 2013 through June 2019 to identify relevant literature published since the last International Patient Decision Aid Standards (IPDAS) update in 2013. We considered research articles that examined the impact of narratives on relevant outcomes or described relevant theoretical mechanisms. Results The majority of the empirical work on narratives did not measure concepts that are typically found in the PtDA literature (e.g., decisional conflict). Yet, a few themes emerged from our review that can be applied to the PtDA context, including the impact of narratives on relevant outcomes (knowledge, behavior change, and psychological constructs), as well as several theoretical mechanisms about how and why narratives work that can be applied to the PtDA context. Conclusion Based on this evidence update, we suggest that there may be situations when narratives could enhance the effectiveness of PtDAs. The recent theoretical work on narratives has underscored the fact that narratives are a multifaceted construct and should no longer be considered a binary option (include narratives or not). However, the bottom line is that the evidence does not support a recommendation for narratives to be a necessary component of PtDAs.

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