In this study, patients with hip or knee arthritis were assessed for their need and willingness to undergo arthroplasty in two geographic regions with high and low use of the procedure. Patients were assessed for this clinical appropriateness for surgery, and then participated in an interview where they were told the consequences of not having surgery, alternative treatments, risks and benefits of surgery, and potential risks of surgery. Among individuals that were deemed clinically appropriate for surgery, only 14.9% in the high-rate area and 8.5% in the low-rate area responded as being definitely willing to undergo arthroplasty. The great variation between those patients who are clinically appropriate versus willing to undergo surgery suggest that patient values should be more routinely incorporated into clinical decisions.
This article discusses the use of patient decision aids in routine clinical practice for patients considering knee replacement surgery. The decision surrounding a diagnosis of knee osteoarthritis is an example of a preference-sensitive decision, meaning there is more than one viable option. Unfortunately, when patients are not fully informed, they are often unsatisfied with the outcome due to unrealistic expectations and a lack of understanding of the potential benefits and harms. The authors describe how implementation of patient decision aids, to support a shared decision making process, may address these issues and improve patient satisfaction, specifically in the context of knee replacement surgery.
To develop effective interventions to redress physicians’ contributions to the gender disparity in TKA utilization and develop tools to measure the effectiveness of these interventions.