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Shared Decision Making in Patients with Osteoarthritis of the Hip and Knee: Results of a Randomized Controlled Trial

Bozic, Kevin J. MD, MBA; Belkora, Jeffrey PhD; Chan, Vanessa MPH; Youm, Jiwon MD, MS; Zhou, Tianzan BS; Dupaix, John MD; Bye, Angela Nava MA, ATC; Braddock, Clarence H. III MD, MPH; Chenok, Kate Eresian MBA; Huddleston, James I. III MD

Journal of Bone & Joint Surgery - American Volume: 18 September 2013 - Volume 95 - Issue 18 - p 1633–1639
doi: 10.2106/JBJS.M.00004
Scientific Articles
Supplementary Content

Background: Despite evidence that shared decision-making tools for treatment decisions improve decision quality and patient engagement, they are not commonly employed in orthopaedic practice. The purpose of this study was to evaluate the impact of decision and communication aids on patient knowledge, efficiency of decision making, treatment choice, and patient and surgeon experience in patients with osteoarthritis of the hip or knee.

Methods: One hundred and twenty-three patients who were considered medically appropriate for hip or knee replacement were randomized to either a shared decision-making intervention or usual care. Patients in the intervention group received a digital video disc and booklet describing the natural history and treatment alternatives for hip and knee osteoarthritis and developed a structured list of questions for their surgeon in consultation with a health coach. Patients in the control group received information about the surgeon’s practice. Both groups reported their knowledge and stage in decision making and their treatment choice, satisfaction, and communication with their surgeon. Surgeons reported the appropriateness of patient questions and their satisfaction with the visit. The primary outcome measure tracked whether patients reached an informed decision during their first visit. Statistical analyses were performed to evaluate differences between groups.

Results: Significantly more patients in the intervention group (58%) reached an informed decision during the first visit compared with the control group (33%) (p = 0.005). The intervention group reported higher confidence in knowing what questions to ask their doctor (p = 0.0034). After the appointment, there was no significant difference between groups in the percentage of patients choosing surgery (p = 0.48). Surgeons rated the number and appropriateness of patient questions higher in the intervention group (p < 0.0001), reported higher satisfaction with the efficiency of the intervention group visits (p < 0.0001), and were more satisfied overall with the intervention group visits (p < 0.0001).

Conclusions: Decision and communication aids used in orthopaedic practice had benefits for both patients and surgeons. These findings could be important in facilitating adoption of shared decision-making tools into routine orthopaedic practice.

Level of Evidence: Therapeutic Level I. See Instructions for Authors for a complete description of levels of evidence.

1Department of Orthopaedic Surgery, University of California, San Francisco, 500 Parnassus Avenue, MU 320W, San Francisco, CA 94143-0728. E-mail address for K.J. Bozic:

2Philip R. Lee Institute for Health Policy Studies, University of California, San Francisco, 3333 California Street, Suite 265, San Francisco, CA 94143-0936

3San Diego School of Medicine, University of California, San Diego, 9500 Gilman Drive, La Jolla, CA 92093

4Department of Orthopaedic Surgery, University of Hawaii, 1356 Lusitana Street, Room 613, Honolulu, HI 96813

5Department of Orthopaedic Surgery, Stanford University Medical Center, 450 Broadway Street, M/C 3142, Redwood City, CA 94063

6Stanford Center for Medical Research and Innovation, 1265 Welch Road, MSOB X333, MC5404, Stanford, CA 94305-5404

7Pacific Business Group on Health, 221 Main Street, Suite 1500, San Francisco, CA 94105

Copyright 2013 by The Journal of Bone and Joint Surgery, Incorporated
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