title: Impact of patient decision aids on appropriate and timely access to hip or knee arthroplasty for osteoarthritis: a randomized controlled trial.
abstract: OBJECTIVE
  To evaluate the effectiveness of patient decision aids (PtDA) compared to usual education on appropriate and timely access to total joint arthroplasty in patients with osteoarthritis.
  
  
  METHODS
  A randomized controlled trial (RCT) with patients undergoing orthopedic screening. Control and intervention arms received usual education; intervention arm also received a PtDA and a surgeon preference report. Wait times (primary outcome) were described using stratified Kaplan-Meier survival curves with patients censored at the time of death or loss to follow-up, and multivariable Cox proportional hazards regression. Secondary outcomes were compared using stratified Cochran-Mantel-Haenszel chi-squared tests.
  
  
  RESULTS
  343 patients were randomized to intervention (n = 174) or control (n = 169). The typical patient was 66 years old, retired, living with someone, and 51% had high school education or less. The intervention was associated with a trend towards reduction in wait time (hazard ratio (HR) 1.25, 95% confidence interval (CI) 0.99-1.60, P = 0.0653). Median wait times were 3 weeks shorter in intervention than in control at the community site with no difference at the academic site. Good decision quality was reached by 56.1% intervention and 44.5% control (Relative risk (RR) 1.25; 95% CI 1.00-1.56, P = 0.050). Surgery rates were 73.2% intervention and 80.5% controls (RR 0.91: 95% CI 0.81-1.03) with 12 intervention (7.3%) and eight control participants (4.9%) returning to have surgery within 2 years (P = 0.791).
  
  
  CONCLUSIONS
  Compared to controls, decision aid recipients had shorter wait times at one site, fewer surgeries, and were more likely to reach good decision quality, but overall effect was not statistically significant.
  
  
  BACKGROUND
  The full trial protocol is available at ClinicalTrials.Gov (NCT00911638).
authors.affiliation: University of Ottawa, Faculty of Health Sciences, Canada; Ottawa Hospital Research Institute, Clinical Epidemiology Program, Canada. Electronic address: dstacey@uottawa.ca.
authors.forename: D
authors.initials: D
authors.lastname: Stacey
authors.affiliation: Ottawa Hospital Research Institute, Clinical Epidemiology Program, Canada; University of Ottawa, Department of Epidemiology and Community Medicine, Canada. Electronic address: mtaljaard@ohri.ca.
authors.forename: M
authors.initials: M
authors.lastname: Taljaard
authors.affiliation: Ottawa Hospital Research Institute, Clinical Epidemiology Program, Canada. Electronic address: gdervin@toh.on.ca.
authors.forename: G
authors.initials: G
authors.lastname: Dervin
authors.affiliation: Ottawa Hospital Research Institute, Clinical Epidemiology Program, Canada; University of Ottawa, Department of Epidemiology and Community Medicine, Canada. Electronic address: Tugwell.BB@uottawa.ca.
authors.forename: P
authors.initials: P
authors.lastname: Tugwell
authors.affiliation: University of Ottawa, Faculty of Health Sciences, Canada. Electronic address: Annette.OConnor@uottawa.ca.
authors.forename: A M
authors.initials: AM
authors.lastname: O'Connor
authors.affiliation: University of Montréal, School of Public Health, Canada. Electronic address: marie-pascale.pomey@umontreal.ca.
authors.forename: M P
authors.initials: MP
authors.lastname: Pomey
authors.affiliation: University of Ottawa, Faculty of Health Sciences, Canada. Electronic address: lbola072@uottawa.ca.
authors.forename: L
authors.initials: L
authors.lastname: Boland
authors.affiliation: Ottawa Hospital Research Institute, Clinical Epidemiology Program, Canada. Electronic address: sbeach@ohri.ca.
authors.forename: S
authors.initials: S
authors.lastname: Beach
authors.affiliation: University of Chicago, Department of Medicine, USA. Electronic address: dmeltzer@medicine.bsd.uchicago.edu.
authors.forename: D
authors.initials: D
authors.lastname: Meltzer
authors.affiliation: University of Toronto, Faculty of Medicine and Women's College Hospital, Canada. Electronic address: g.hawker@utoronto.ca.
authors.forename: G
authors.initials: G
authors.lastname: Hawker
mesh_terms: D000368:Aged; D019644:Arthroplasty, Replacement, Hip; D019645:Arthroplasty, Replacement, Knee; D003220:Conflict, Psychological; D003657:Decision Making; D003661:Decision Support Techniques; D005260:Female; D006297:Health Services Accessibility; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D015207:Osteoarthritis, Hip / Q000601:surgery*; D020370:Osteoarthritis, Knee / Q000601:surgery*; D010358:Patient Participation; D016016:Proportional Hazards Models; D016037:Single-Blind Method; D013997:Time Factors; D061665:Time-to-Treatment / Q000706:statistics & numerical data*
keywords: Joint arthroplasty; Osteoarthritis; Patient decision aid; Randomized controlled trial; Shared decision making