Decision Aids Effect on Treatment Choices

Shared decision-making is a core approach to getting patients more involved in the treatment of their health conditions.  Research in Health Affairs explores if and how decision aids used in that shared-decision making process effect patient choices.   (HA Article)   The authors used hip and knee osteoarthritis, common problems, especially among the elderly, as the test bed.  Prior research has been inconsistent on whether use of decision aids led to fewer surgeries.  The study was conducted by a group of ten health care systems who have banded together for research purposes.  Adults who were exposed to decision aids were compared to those who were not over a three year period.  The groups were matched on relevant characteristics.  Other than exposure to the decision aid, typically a video or written material, the patients’ care in the intervention and control groups was the same.  The primary outcome was whether or not the patient had hip or knee surgery in the 6 months following exposure to the decision aids.  On an unadjusted basis, the intervention group had a 54% hip surgery rate versus 29% in the control group and a 32% knee surgery rate versus 24% in the controls.  Adjustment on a number of characteristics reduced these differences somewhat but they remained significant.  The authors concluded that exposure to the decision aids did not have a negative effect on the rate of surgeries, in fact the patients who viewed the decision aids appeared more likely to have a surgery.  There are some limitations to the study in terms of understanding how patients reacted to the decision aids and what the total set of discussions with their treating physicians was.  Surgeons are probably inclined to recommend surgery.  One supposed rationale for shared decision-making is that it will ensure fidelity to patient preferences and will limit unnecessary procedures.  Apparently patients may not be quick to think a procedure is unnecessary, even after exposure to extensive discussion about the risks and benefits.  Even if involving patients in decision-making doesn’t reduce what some might deem to be unnecessary care, it is clearly the right thing to do.