Lo Yu-Chieh, Chen Yu-Pin, Lin Hui En, Chang Wei-Chun, Ho Wei-Pin, Jang Jia-Pei, Kuo Yi-Jie
Department of Orthopedics, Taichung Veterans General Hospital, Taichung 407219, Taiwan.
Department of Orthopedics, Wan Fang Hospital, Taipei Medical University, Taipei 11031, Taiwan.
Healthcare (Basel). 2025 Jul 3;13(13):1597. doi: 10.3390/healthcare13131597.
Total knee arthroplasty (TKA) is a treatment for knee pain, but some patients are not satisfied with their outcomes. Utilizing shared decision making (SDM) can lead to better decisions, satisfaction, and fewer regrets. However, healthcare professionals have little knowledge of risk factors for regret. The aim of this study is to evaluate decisional regret using the Decision Regret Scale (DRS) after primary TKA among patients who engaged in SDM. A total of 118 patients who underwent TKA surgery between March 2020 and May 2022 participated in this study, and they were able to reflect on their outcomes. The primary outcome was decisional regret assessed using the DRS, and the secondary outcome was post-operative pain at a three-month follow-up, measured using the Lequesne Index. The study found that 49% of the patients reported no regret, 25% reported mild regret, and 26% reported moderate-to-severe regret. There was a significant correlation between greater levels of decision regret and a higher three-month Lequesne Index. Post-operative pain and post-operative mobility status and the range of motion of the knee joint were also strongly correlated. The study found that more than half of the patients undergoing primary TKAs experienced regret even following SDM counseling. Regret levels were associated with higher post-operative pain and poorer mobility. This underscores the importance of informing patients about potential adverse effects of TKA to manage their expectations and reduce regret in future SDM interviews. This study incorporated patient perspectives through their direct engagement in the SDM process prior to surgery. Patients participated in the design of the SDM framework, which included educational pamphlets and structured interviews to assess their values and preferences. Their involvement ensured that the SDM procedure was tailored to patient-centered outcomes. Furthermore, the follow-up assessments were conducted with patients to evaluate decisional regret and post-operative outcomes, providing valuable insights into the effectiveness of the SDM process. By actively participating in the research through decision making and outcome reflection, the patients contributed to the understanding of factors influencing decisional regret after undergoing TKA.
全膝关节置换术（TKA）是一种治疗膝关节疼痛的方法，但一些患者对其治疗效果并不满意。采用共同决策（SDM）可以做出更好的决策、提高满意度并减少遗憾。然而，医疗保健专业人员对导致遗憾的风险因素了解甚少。本研究的目的是使用决策遗憾量表（DRS）评估参与共同决策的患者在初次全膝关节置换术后的决策遗憾。共有118名在2020年3月至2022年5月期间接受全膝关节置换手术的患者参与了本研究，他们能够对自己的治疗效果进行反思。主要结果是使用DRS评估的决策遗憾，次要结果是在三个月随访时使用Lequesne指数测量的术后疼痛。研究发现，49%的患者表示没有遗憾，25%的患者表示有轻微遗憾，26%的患者表示有中度至重度遗憾。决策遗憾程度越高与三个月时更高的Lequesne指数之间存在显著相关性。术后疼痛、术后活动状态和膝关节活动范围也密切相关。研究发现，即使在接受共同决策咨询后，超过一半接受初次全膝关节置换术的患者仍感到遗憾。遗憾程度与术后疼痛加剧和活动能力较差有关。这凸显了在未来的共同决策访谈中告知患者全膝关节置换术潜在不良影响以管理其期望并减少遗憾的重要性。本研究通过让患者在手术前直接参与共同决策过程纳入了患者的观点。患者参与了共同决策框架的设计，该框架包括教育手册和结构化访谈以评估他们的价值观和偏好。他们的参与确保了共同决策程序是根据以患者为中心的结果量身定制的。此外，对患者进行了随访评估以评估决策遗憾和术后结果，为共同决策过程的有效性提供了有价值的见解。通过积极参与决策和结果反思的研究，患者有助于了解影响全膝关节置换术后决策遗憾的因素。
