Abstract
ObjectiveThe aim of the present study was to explore patient-related barriers and facilitators towards shared decision-making (SDM) during routine orthopedic outpatient consultations as part of the process of developing a patient decision aid (PDA) for patients with hip osteoarthritis (OA). MethodsConsultations comprising nineteen hip OA patients referred to an orthopedic surgeon for treatment decision-making were observed, audio recorded and transcribed. Iterative thematic analysis proceeded, based on a taxonomy of generic patient-related barriers towards SDM grounded in the Theory of Planned Behavior (TPB). ResultsA targeted taxonomy provided a structured overview of 26 factors influencing hip OA patients’ intention to engage in SDM. Patients’ perceived ability to change the agenda of the visit emerged as seminal factor and was added to the generic taxonomy. ConclusionUsing a TPB-based taxonomy, we were able to identify and structure generic and context specific SDM barriers. Addressing patients’ communication self-efficacy should be included as didactic feature in PDAs. Practice implicationsPDAs for hip OA should be designed for the broad spectrum of decision-making support needs occurring throughout the continuum of the disease. The provided taxonomy may contribute as guidance within implementation strategies that aim to support patients’ intentions to engage in SDM.
Highlights
Worldwide, osteoarthritis (OA) represents a major cause of chronic musculoskeletal pain and physical disability [1]
We found that hip OA patients face similar barriers towards shared decision-making (SDM) as those previously identified in other patient groups
OA patients seem to find it challenging to engage actively in treatment decision-making when consultations are framed around diagnostic decisions
Summary
Osteoarthritis (OA) represents a major cause of chronic musculoskeletal pain and physical disability [1]. Decisionmaking in OA treatment requires active involvement of patients for many reasons. Treatment options for hip OA range from education, physical therapy, pacing of activities, weight reduction and pharmacological treatment to invasive surgery involving total hip replacement (THR) [3,4,5]. With regard to their impact on lifestyle, and in particular the potentially long timeframes within which such decisions can be made, all of them are considered sensitive to individual preferences [6,7]. A major challenge is, the identification and optimal timing of appropriate decisions [9,10], and how to adopt communication strategies that promote informed choice [11]
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