Informed choice and the widespread use of antiinflammatory drugs.
OBJECTIVE
To examine whether the current widespread use of antiinflammatory drugs may reflect a lack of informed choice (i.e., unawareness of adverse effects or potential treatment alternatives) among older patients with knee osteoarthritis (OA).


METHODS
Consecutive patients with symptomatic knee OA (n = 100) completed a questionnaire to assess their awareness of drug toxicity. Patients also completed an Adaptive Conjoint Analysis task so that the influence of providing an additional treatment alternative on patient preferences for nonselective nonsteroidal antiinflammatory drugs (NSAIDs) and cyclooxygenase-2 (COX-2) inhibitors could be assessed.


RESULTS
Fifty-four percent of the patients surveyed were unaware of any adverse effects related to NSAIDs and 80% were unaware of any toxicity related to COX-2 inhibitors. When given a choice between NSAIDs and COX-2 inhibitors, 57% of patients preferred COX-2 inhibitors over NSAIDs. When presented with a third less effective, but safer alternative, 100% of patients switched preferences to the safer, albeit less effective, option.


CONCLUSIONS
Our findings suggest that the widespread use of NSAIDs may reflect lack of informed choice among older patients with OA.
Fraenkel
Liana
L
Veteran's Affairs Connecticut Healthcare System and Yale University, New Haven, Connecticut, USA. liana.fraenkel@yale.edu
Wittink
Dick R
DR
Concato
John
J
Fried
Terri
T
D000368:Aged; D000369:Aged, 80 and over; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000008:administration & dosage* / Q000009:adverse effects*; D016861:Cyclooxygenase Inhibitors / Q000008:administration & dosage* / Q000009:adverse effects*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D020370:Osteoarthritis, Knee / Q000188:drug therapy*; D010353:Patient Education as Topic; D017060:Patient Satisfaction; D012959:Socioeconomic Factors; D011795:Surveys and Questionnaires
D000894:Anti-Inflammatory Agents, Non-Steroidal; D016861:Cyclooxygenase Inhibitors