title: Impact of educational and patient decision aids on decisional conflict associated with total knee arthroplasty.
abstract: OBJECTIVE
  To examine the impact of a videobooklet patient decision aid supplemented by an interactive values clarification exercise on decisional conflict in patients with knee osteoarthritis (OA) considering total knee arthroplasty.
  
  
  METHODS
  A total of 208 patients participated in the study (mean age 63 years, 68% female, and 66% white). Participants were randomized to 1 of 3 groups: 1) educational booklet on OA management (control), 2) patient decision aid (videobooklet) on OA management, and 3) patient decision aid (videobooklet) + adaptive conjoint analysis (ACA) tool. The ACA tool enables patients to consider competing attributes (i.e., specific risks/benefits) by asking them to rate a series of paired comparisons. The primary outcome was the decisional conflict scale ranging from 0-100. Differences between groups were analyzed using analysis of variance and Tukey's honestly significant difference tests.
  
  
  RESULTS
  Overall, decisional conflict decreased significantly in all groups (P < 0.05). The largest reduction in decisional conflict was observed for participants in the videobooklet decision aid group (21 points). Statistically significant differences in pre- versus postintervention total scores favored the videobooklet group compared to the control group (21 versus 10) and to the videobooklet plus ACA group (21 versus 14; P < 0.001). Changes in the decisional conflict score for the control group compared to the videobooklet decision aid + ACA group were not significantly different.
  
  
  CONCLUSIONS
  In our study, an audiovisual patient decision aid decreased decisional conflict more than printed material alone or the addition of a more complex computer-based ACA tool requiring more intense cognitive involvement and explicit value choices.
authors.affiliation: University of Texas MD Anderson Cancer Center, Houston, USA.
authors.forename: Sofia
authors.initials: S
authors.lastname: de Achaval
authors.forename: Liana
authors.initials: L
authors.lastname: Fraenkel
authors.forename: Robert J
authors.initials: RJ
authors.lastname: Volk
authors.forename: Vanessa
authors.initials: V
authors.lastname: Cox
authors.forename: Maria E
authors.initials: ME
authors.lastname: Suarez-Almazor
mesh_terms: D019645:Arthroplasty, Replacement, Knee / Q000193:education / Q000523:psychology; D003220:Conflict, Psychological; D003657:Decision Making; D003661:Decision Support Techniques; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D020370:Osteoarthritis, Knee / Q000175:diagnosis / Q000523:psychology* / Q000601:surgery; D010353:Patient Education as Topic; D010358:Patient Participation; D014743:Videotape Recording