Long Term Assessment of Patient Treatment Preferences for Knee Osteoarthritis
Osteoarthritis (OA) of the knee affects over 30 million people in the US. It significantly impacts their quality of life and is a chronic condition, worsening over time. Several treatment options are available to alieve pain, however there is no cure. As symptoms worsen, many patients consider more invasive treatment options, even total knee replacement. The decision to progress from conservative treatment options to more invasive treatment options is a difficult one for patients. Implementation of a decision aid can alleviate decision uncertainty, also known as decisional conflict. We previously evaluated the immediate impact on decisional conflict, however the long-term effects are unknown. We proposed to understand the long-term effect of a decision on decisional conflict, to understand changes in treatment preferences and decision regret one year after the intervention in surgery-naïve patients with knee OA. We conducted a randomized control trial in which patients were randomized into one of three groups after completing a set of pre-intervention questionnaires: Group 1 receiving educational material from the National Institutes of Health about OA; Group 2 viewing a decision aid videobooklet; and Group 3 viewing the videobooklet and participating in adaptive conjoint analysis (ACA). We measured decisional conflict using the decisional conflict scale one year after receiving the intervention. We evaluated treatment preferences using a self-reported questionnaire with the following options and we measured decision regret using the validated decision regret scale. A total of 189 participated in the 12 month follow-up study and were included in the analysis. After one year, regardless of intervention group, the decisional conflict scale score decreased among the participants, resulting in no statistically significant difference in decisional conflict scale scores between groups. We also found over half of the participants changed their treatment preferences over the one year period, and decision regret was highest amongst participants who were unsure of their treatment preference suggesting their decision-making process was incomplete and they were still considering different treatment options (deliberation process). Future studies may take advantage of the disease duration of knee OA and provide multiple educational and decision aid opportunities over time as the disease progresses.
de Achaval, Sofia, "Long Term Assessment of Patient Treatment Preferences for Knee Osteoarthritis" (2018). Texas Medical Center Dissertations (via ProQuest). AAI10790169.