Barlow Timothy, Scott Patricia, Griffin Damian, Realpe Alba
CSB, University of Warwick, UHCW, Clifford Bridge Road, Coventry, CV2 2DX, UK.
BMC Musculoskelet Disord. 2016 Jul 22;17:304. doi: 10.1186/s12891-016-1165-x.
There is approximately a 17 % dissatisfaction rate with knee replacements. Calls for tools that can pre-operatively identify patients at risk of being dissatisfied have been widespread. However, it is not known how to present such information to patients, how it would affect their decision making process, and at what part of the pathway such a tool should be used.
Using focus groups involving 12 participants and in-depth interviews with 10 participants, we examined how individual predictions of outcome could affect patients' decision making by providing fictitious predictions to patients at different stages of treatment. A thematic analysis was used to analyse the data.
Our results demonstrate several interesting findings. Firstly, patients who have received information from friends and family are unwilling to adjust their expectation of outcome down (i.e. to a worse outcome), but highly willing to adjust it up (to a better outcome). This is an example of the optimism bias, and suggests that the effect on expectation of a poor outcome prediction would be blunted. Secondly, patients generally wanted a "bottom line" outcome, rather than lots of detail. Thirdly, patients who were earlier in their treatment for osteoarthritis were more likely to find the information useful, and it was more likely to affect their decision, than patients later in their treatment pathway.
This research suggest that an outcome prediction tool would have most effect targeted towards people at the start of their treatment pathway, with a "bottom line" prediction of outcome. However, any effect on expectation and decision making of a poor outcome prediction is likely to be blunted by the optimism bias. These findings merit replication in a larger sample size.
膝关节置换术的不满意率约为17%。人们普遍呼吁使用能够在术前识别出有不满意风险患者的工具。然而，目前尚不清楚如何向患者呈现此类信息，它将如何影响患者的决策过程，以及该工具应在治疗流程的哪个阶段使用。
我们通过12名参与者的焦点小组以及对10名参与者的深入访谈，研究了通过在治疗的不同阶段向患者提供虚拟预测结果，个体结果预测如何影响患者的决策。采用主题分析法对数据进行分析。
我们的结果显示了几个有趣的发现。首先，从朋友和家人那里获得信息的患者不愿意降低对结果的期望（即降至更差的结果），但非常愿意提高期望（至更好的结果）。这是乐观偏差的一个例子，表明对不良结果预测的期望影响会减弱。其次，患者通常想要一个“底线”结果，而不是大量细节。第三，与治疗后期的患者相比，骨关节炎治疗早期的患者更有可能认为这些信息有用，且更有可能影响他们的决策。
本研究表明，结果预测工具对治疗流程开始阶段的人群效果最佳，预测结果为“底线”结果。然而，乐观偏差可能会减弱不良结果预测对期望和决策的任何影响。这些发现值得在更大样本中进行重复验证。
