Acceptability and Feasibility of Delivering Decision Aids to Veterans for Management of Knee Osteoarthritis – A Pilot Study

Abstract

Clifford A Reilly,1 Makenna L Rice,2 Dylan J Parker,2 Philip P Goodney,3– 6 Jon D Lurie,3,4 Said A Ibrahim,7,8 Eric R Henderson2,4,6 1Larner College of Medicine, University of Vermont, Burlington, VT, USA; 2Department of Orthopaedic Surgery, Dartmouth Hitchcock Medical Center, Lebanon, NH, USA; 3The Dartmouth Institute for Health Policy and Clinical Practice, Dartmouth College, Hanover, NH, USA; 4Geisel School of Medicine, Dartmouth College, Hanover, NH, USA; 5Heart and Vascular Center, Dartmouth Hitchcock Medical Center, Lebanon, NH, USA; 6White River Junction VA Medical Center, US Department of Veterans Affairs, White River Junction, VT, USA; 7Zucker School of Medicine, Hofstra University/Northwell Health, Hempstead, NY, USA; 8Department of Medicine, Long Island Jewish Medical Center, New Hyde Park, NY, USACorrespondence: Makenna L Rice, Department of Orthopaedic Surgery, Dartmouth Hitchcock Medical Center, 1 Medical Center Dr, Rubin 592, Lebanon, NH, 03756, USA, Tel [phone], Fax [phone], Email [email protected]: Decision aids are effective tools in facilitating patient-centered care and patient involvement in the decision-making process. Given unique barriers to providing patient-centered care for Veterans, implementation of decision aids may improve overall quality of care. We aimed to assess the acceptability and feasibility of video-based and pamphlet-based decision aid use in Veterans with knee osteoarthritis.Materials and Methods: Veterans considering treatment for knee osteoarthritis received either an online video-based aid, pamphlet-based aid, or both before their surgical consult. At their visit, patients completed written pre-visit and post-visit questionnaires. The pre-visit questionnaire included questions about the patient’s demographics, decision-making preferences, experiences using the assigned decision aids, and the Hip-Knee Decision Quality Instrument. The post-visit questionnaire assessed the patient’s overall experience with the decision-making process and how use of the decision aid influenced their discussion with the physician.Results: All 16 patients who received the pamphlet-based aid reviewed the decision aid before their visit, compared to only five of the 12 patients who received the video-based aid. Thirteen of 20 patients indicated that they preferred to share treatment decision-making with their physician. Seventeen of 20 patients believed they would feel comfortable questioning the treatment recommendation of their surgeon after decision aid use. Most patients reported a positive experience using their decision aid, regardless of modality, and found it easily comprehensible and useful in visit preparation. A preference for a pamphlet-based aid was expressed by the majority of patients.Conclusion: Veterans considering treatment for knee osteoarthritis are well prepared to engage in a patient-centered care experience. Most patients preferred sharing the decision-making process with their physician and felt comfortable questioning them about treatment recommendations. Decision aids helped Veterans feel more informed about their treatment options and improved engagement and discussion with their physician. Pamphlet-based aids were utilized more reliably than video-based aids.Keywords: patient-centered care, shared decision-making, decision aid, knee osteoarthritis, military service

Keywords

• patient-centered care
• shared decision-making
• decision aid
• knee osteoarthritis
• military service