title: Informed choice and the widespread use of antiinflammatory drugs.
abstract: 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.
authors.affiliation: Veteran's Affairs Connecticut Healthcare System and Yale University, New Haven, Connecticut, USA. liana.fraenkel@yale.edu
authors.forename: Liana
authors.initials: L
authors.lastname: Fraenkel
authors.forename: Dick R
authors.initials: DR
authors.lastname: Wittink
authors.forename: John
authors.initials: J
authors.lastname: Concato
authors.forename: Terri
authors.initials: T
authors.lastname: Fried
mesh_terms: 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
chemical_list: D000894:Anti-Inflammatory Agents, Non-Steroidal; D016861:Cyclooxygenase Inhibitors