title: Factors associated with the quality of patients' surgical decisions for treatment of hip and knee osteoarthritis.
abstract: BACKGROUND
  Shared decision making requires informing patients and ensuring that treatment decisions reflect their goals. It is not clear to what extent this happens for patients considering total joint replacement (TJR) for hip or knee osteoarthritis.
  
  
  METHODS
  We conducted a cross-sectional mail survey of osteoarthritis patients at 4 sites, who made a decision about TJR. The survey measured knowledge and goals, the decision making process, decision confidence, and decision regret. Decision quality was defined as the percentage of patients who had high knowledge scores and received treatments that matched their goals. Multivariable regression models examined factors associated with knowledge and decision quality.
  
  
  RESULTS
  There were 382 patients who participated (78.6% response rate). Mean knowledge score was 61% (SD 20.7%). In multivariate linear regression, higher education, having TJR, and site were associated with higher knowledge. Many patients (73%) received treatments that matched their goals. Thirty-one percent of patients met our definition for high decision quality. Higher decision making process scores, higher quality of life scores, and site were associated with higher decision quality. Patients who had high decision quality had less regret (73.1% vs 58.5%, p = 0.007) and greater confidence (9.0 [SD 1.6] vs 8.2 [SD 2.3] out of 10, p < 0.001).
  
  
  CONCLUSIONS
  A third of patients who recently made a decision about osteoarthritis treatment met both criteria for a high quality decision. Controlling for treatment, patients reporting more involvement in the decision making process, higher quality of life, and being seen at a site that uses decision aids were associated with higher decision quality.
authors.affiliation: Division of General Internal Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA. Electronic address: ksepucha@partners.org.
authors.forename: Karen
authors.initials: K
authors.lastname: Sepucha
authors.forename: Sandra
authors.initials: S
authors.lastname: Feibelmann
authors.forename: Yuchiao
authors.initials: Y
authors.lastname: Chang
authors.forename: Catharine F
authors.initials: CF
authors.lastname: Clay
authors.forename: Stephen A
authors.initials: SA
authors.lastname: Kearing
authors.forename: Ivan
authors.initials: I
authors.lastname: Tomek
authors.forename: Theresa
authors.initials: T
authors.lastname: Yang
authors.forename: Jeffrey N
authors.initials: JN
authors.lastname: Katz
mesh_terms: D000368:Aged; D019643:Arthroplasty, Replacement; D003430:Cross-Sectional Studies; D003657:Decision Making; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D008297:Male; D008875:Middle Aged; D015207:Osteoarthritis, Hip / Q000523:psychology* / Q000601:surgery; D020370:Osteoarthritis, Knee / Q000523:psychology* / Q000601:surgery; D010358:Patient Participation; D057240:Patient Preference; D012189:Retrospective Studies