title: Supporting shared decision making using an Option Grid for osteoarthritis of the knee in an interface musculoskeletal clinic: A stepped wedge trial.
abstract: OBJECTIVE
  To evaluate whether introducing tools, specifically designed for use in clinical encounters, namely Option Grids, into a clinical practice setting leads to higher levels of shared decision making.
  
  
  METHODS
  A stepped wedge trial design where 6 physiotherapists at an interface clinic in Oldham, UK, were sequentially instructed in how to use an Option Grid for osteoarthritis of the knee. Patients with suspected or confirmed osteoarthritis of the knee were recruited, six per clinician prior to instruction, and six per clinician afterwards. We measured shared decision making, patient knowledge, and readiness to decide.
  
  
  RESULTS
  A total of 72 patients were recruited; 36 were allocated to the intervention group. There was an 8.4 point (95% CI 4.4 to 12.2) increase in the Observer OPTION score (range 0-100) in the intervention group. The mean gain in knowledge was 0.9 points (score range 0-5, 95% CI, 0.3 to 1.5). There was no increase in encounter duration.
  
  
  CONCLUSIONS
  Shared decision making increased when clinicians used the knee osteoarthritis Option Grid.
  
  
  CONCLUSIONS
  Tools designed to support collaboration and deliberation about treatment options lead to increased levels of shared decision making.
authors.affiliation: The Dartmouth Institute for Health Policy and Clinical Practice, Dartmouth College, Hanover, NH, USA. Electronic address: glynelwyn@gmail.com.
authors.forename: Glyn
authors.initials: G
authors.lastname: Elwyn
authors.affiliation: South East Wales Trials Unit, Cardiff University, Cardiff, UK.
authors.forename: Tim
authors.initials: T
authors.lastname: Pickles
authors.affiliation: Cochrane Institute for Primary Care and Public Health, Cardiff University, Cardiff, UK.
authors.forename: Adrian
authors.initials: A
authors.lastname: Edwards
authors.affiliation: Pennine MSK Partnership Ltd., Integrated Care Centre, Oldham, UK.
authors.forename: Katharine
authors.initials: K
authors.lastname: Kinsey
authors.affiliation: Cochrane Institute for Primary Care and Public Health, Cardiff University, Cardiff, UK.
authors.forename: Kate
authors.initials: K
authors.lastname: Brain
authors.affiliation: Cochrane Institute for Primary Care and Public Health, Cardiff University, Cardiff, UK.
authors.forename: Robert G
authors.initials: RG
authors.lastname: Newcombe
authors.affiliation: Pennine MSK Partnership Ltd., Integrated Care Centre, Oldham, UK.
authors.forename: Jill
authors.initials: J
authors.lastname: Firth
authors.affiliation: Independent Research and Evaluation Consultant, Cardiff, UK.
authors.forename: Katy
authors.initials: K
authors.lastname: Marrin
authors.affiliation: Pennine MSK Partnership Ltd., Integrated Care Centre, Oldham, UK.
authors.forename: Alan
authors.initials: A
authors.lastname: Nye
authors.affiliation: Cochrane Institute for Primary Care and Public Health, Cardiff University, Cardiff, UK.
authors.forename: Fiona
authors.initials: F
authors.lastname: Wood
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000554:Ambulatory Care Facilities; D003142:Communication; D003299:Cooperative Behavior; D003657:Decision Making; D003661:Decision Support Techniques; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D020370:Osteoarthritis, Knee / Q000628:therapy*; D010043:Outcome and Process Assessment, Health Care; D010358:Patient Participation; D018802:Patient-Centered Care; D010817:Physician-Patient Relations; D006113:United Kingdom
keywords: Collaborative deliberation; Option Grids; Patient decision aids; Shared decision making