title: Decision quality instrument for treatment of hip and knee osteoarthritis: a psychometric evaluation.
abstract: BACKGROUND
  A high quality decision requires that patients who meet clinical criteria for surgery are informed about the options (including non-surgical alternatives) and receive treatments that match their goals. The aim of this study was to evaluate the psychometric properties and clinical sensibility of a patient self report instrument, to measure the quality of decisions about total joint replacement for knee or hip osteoarthritis.
  
  
  METHODS
  The performance of the Hip/Knee Osteoarthritis Decision Quality Instrument (HK-DQI) was evaluated in two samples: (1) a cross-sectional mail survey with 489 patients and 77 providers (study 1); and (2) a randomized controlled trial of a patient decision aid with 138 osteoarthritis patients considering total joint replacement (study 2). The HK-DQI results in two scores. Knowledge items are summed to create a total knowledge score, and a set of goals and concerns are used in a logistic regression model to develop a concordance score. The concordance score measures the proportion of patients whose treatment matched their goals. Hypotheses related to acceptability, feasibility, reliability and validity of the knowledge and concordance scores were examined.
  
  
  RESULTS
  In study 1, the HK-DQI was completed by 382 patients (79%) and 45 providers (58%), and in study 2 by 127 patients (92%), with low rates of missing data. The DQI-knowledge score was reproducible (ICC = 0.81) and demonstrated discriminant validity (68% decision aid vs. 54% control, and 78% providers vs. 61% patients) and content validity. The concordance score demonstrated predictive validity, as patients whose treatments were concordant with their goals had more confidence and less regret with their decision compared to those who did not.
  
  
  CONCLUSIONS
  The HK-DQI is feasible and acceptable to patients. It can be used to assess whether patients with osteoarthritis are making informed decisions about surgery that are concordant with their goals.
authors: General Medicine Division, Massachusetts General Hospital (MGH), Harvard Medical School (HMS), Boston, MA, USA. ksepucha@partners.org
authors: Karen R
authors: KR
authors: Sepucha
authors: Dawn
authors: D
authors: Stacey
authors: Catharine F
authors: CF
authors: Clay
authors: Yuchiao
authors: Y
authors: Chang
authors: Carol
authors: C
authors: Cosenza
authors: Geoffrey
authors: G
authors: Dervin
authors: Janet
authors: J
authors: Dorrwachter
authors: Sandra
authors: S
authors: Feibelmann
authors: Jeffrey N
authors: JN
authors: Katz
authors: Stephen A
authors: SA
authors: Kearing
authors: Henrik
authors: H
authors: Malchau
authors: Monica
authors: M
authors: Taljaard
authors: Ivan
authors: I
authors: Tomek
authors: Peter
authors: P
authors: Tugwell
authors: Carrie A
authors: CA
authors: Levin
mesh_terms: D000368:Aged; D003430:Cross-Sectional Studies; D059026:Diagnostic Self Evaluation; D005260:Female; D019538:Health Care Surveys / Q000379:methods / Q000592:standards*; D006801:Humans; D007258:Informed Consent / Q000523:psychology / Q000592:standards; D008297:Male; D008875:Middle Aged; D015207:Osteoarthritis, Hip / Q000523:psychology / Q000628:therapy*; D020370:Osteoarthritis, Knee / Q000523:psychology / Q000628:therapy*; D010353:Patient Education as Topic / Q000379:methods / Q000592:standards*; D011594:Psychometrics / Q000379:methods* / Q000592:standards; D011785:Quality Assurance, Health Care / Q000379:methods / Q000592:standards; D015203:Reproducibility of Results; D011795:Surveys and Questionnaires / Q000592:standards