title: Decision aid for patients considering total knee arthroplasty with preference report for surgeons: a pilot randomized controlled trial.
abstract: BACKGROUND
  To evaluate feasibility and potential effectiveness of a patient decision aid (PtDA) for patients and a preference report for surgeons to reduce wait times and improve decision quality in patients with osteoarthritis considering total knee replacement.
  
  
  METHODS
  A prospective two-arm pilot randomized controlled trial. Patients with osteoarthritis were eligible if they understood English and were referred for surgical consultation about an initial total knee arthroplasty at a Canadian orthopaedic joint assessment clinic. Patients were randomized to the PtDA intervention or usual education. The intervention was an osteoarthritis PtDA for patients and a one-page preference report summarizing patients' clinical and decisional data for their surgeon. The main feasibility outcomes were rates of recruitment and questionnaire completion; the preliminary effectiveness outcomes were wait times and decision quality.
  
  
  RESULTS
  Of 180 patients eligible for surgical consultation, 142 (79%) were recruited and randomized to the PtDA intervention (n = 71) or usual education (n = 71). Data collection yielded a 93% questionnaire completion rate with less than 1% missing items. After one year, 13% of patients remained on the surgical wait list. The median time from referral to being off the wait list (censored using survival analysis techniques) was 33.4 weeks for the PtDA group (n = 69, 95% CI: 26.0, 41.4) and 33.0 weeks for usual education (n = 71, 95% CI: 26.1, 39.9). Patients exposed to the PtDA had higher decision quality based on knowledge (71% versus 47%; p < 0.0001) and quality decision being an informed choice that is consistent with their values for option outcomes (56.4% versus 25.0%; p < 0.001).
  
  
  CONCLUSIONS
  Recruitment of patients with osteoarthritis considering surgery and data collection were feasible. As some patients remained on the surgical waiting list after one year, follow-up should be extended to two years. Patients exposed to the PtDA achieved higher decision quality compared to those receiving usual education but there was no difference in wait for surgery.
  
  
  BACKGROUND
  ClinicalTrials.Gov NCT00743951.
authors.affiliation: University of Ottawa, 451 Smyth Road, Ottawa, ON K1H 8M5, Canada. dstacey@uottawa.ca.
authors.forename: Dawn
authors.initials: D
authors.lastname: Stacey
authors.forename: Gillian
authors.initials: G
authors.lastname: Hawker
authors.forename: Geoffrey
authors.initials: G
authors.lastname: Dervin
authors.forename: Peter
authors.initials: P
authors.lastname: Tugwell
authors.forename: Laura
authors.initials: L
authors.lastname: Boland
authors.forename: Marie-Pascale
authors.initials: MP
authors.lastname: Pomey
authors.forename: Annette M
authors.initials: AM
authors.lastname: O'Connor
authors.forename: Monica
authors.initials: M
authors.lastname: Taljaard
mesh_terms: D000368:Aged; D019645:Arthroplasty, Replacement, Knee / Q000523:psychology; D002755:Choice Behavior; D003661:Decision Support Techniques; D005240:Feasibility Studies; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D008297:Male; D008875:Middle Aged; D015207:Osteoarthritis, Hip / Q000150:complications; D020370:Osteoarthritis, Knee / Q000523:psychology / Q000601:surgery*; D010174:Pamphlets; D010353:Patient Education as Topic; D010358:Patient Participation; D057240:Patient Preference; D010865:Pilot Projects; D017410:Practice Guidelines as Topic; D011446:Prospective Studies; D012017:Referral and Consultation; D011795:Surveys and Questionnaires; D013664:Teaching Materials; D062606:Tertiary Care Centers; D014741:Video Recording; D014850:Waiting Lists