Department 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:
J Bone Joint Surg Am. 2013 Sep 18;95(18):1633-9. doi: 10.2106/JBJS.M.00004.
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.
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.
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).
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.
尽管有证据表明，用于治疗决策的共同决策工具可以提高决策质量和患者参与度，但它们在骨科实践中并未得到广泛应用。本研究的目的是评估决策和沟通辅助工具对髋关节或膝关节骨关节炎患者的知识、决策效率、治疗选择以及患者和外科医生体验的影响。
将 123 名被认为适合接受髋关节或膝关节置换手术的患者随机分为共同决策干预组或常规护理组。干预组患者接受数字视频光盘和小册子，介绍髋关节和膝关节骨关节炎的自然病史和治疗选择，并与健康教练一起制定一份针对外科医生的结构化问题清单。对照组患者获得有关外科医生实践的信息。两组患者均报告其知识和决策阶段以及治疗选择、满意度和与外科医生的沟通情况。外科医生报告患者问题的适当性及其对就诊的满意度。主要结局指标是跟踪患者在首次就诊时是否做出知情决策。进行了统计学分析以评估组间差异。
干预组（58%）在首次就诊时做出知情决策的患者明显多于对照组（33%）（p = 0.005）。干预组患者报告对了解要向医生询问哪些问题更有信心（p = 0.0034）。就诊后，两组选择手术的患者比例无显著差异（p = 0.48）。外科医生认为干预组患者的问题数量和适当性更高（p < 0.0001），对干预组就诊效率的满意度更高（p < 0.0001），对干预组就诊的总体满意度更高（p < 0.0001）。
在骨科实践中使用决策和沟通辅助工具对患者和外科医生都有好处。这些发现对于促进共同决策工具在常规骨科实践中的应用可能很重要。
