Current Status and Future Prospects for Shared Decision Making Before and After Total Knee Replacement Surgery-A Scoping Review.

Geert Van Der Sluis,Ilona Punt,Richard Bimmel,Maria W G Nijhuis-Van Der Sanden,Jelmer Jager,Marjan J Meinders,Thomas J Hoogeboom,Alexandra Goldbohm,Nico L.U Van Meeteren

doi:10.3390/ijerph18020668

Abstract

Background. To gain insight into the current state-of-the-art of shared decision making (SDM) during decisions related to pre and postoperative care process regarding primary total knee replacement (TKR). Methods. A scoping review was performed to synthesize existing scientific research regarding (1) decisional needs and preferences of patients preparing for, undergoing and recovering from TKR surgery, (2) the relation between TKR decision-support interventions and SDM elements (i.e., team talk, option talk, and decision talk), (3) the extent to which TKR decision-support interventions address patients’ decisional needs and preferences. Results. 2526 articles were identified, of which 17 articles met the inclusion criteria. Of the 17 articles, ten had a qualitative study design and seven had a quantitative study design. All included articles focused on the decision whether to undergo TKR surgery or not. Ten articles (all qualitative) examined patients’ decisional needs and preferences. From these, we identified four domains that affected the patients’ decision to undergo TKR: (1) personal factors, (2) external factors, (3) information sources and (4) preferences towards outcome prediction. Seven studies (5) randomized controlled trials and 2 cohort studies) used quantitative analyses to probe the effect of decision aids on SDM and/or clinical outcomes. In general, existing decision aids did not appear to be tailored to patient needs and preferences, nor were the principles of SDM well-articulated in the design of decision aids. Conclusions. SDM in TKR care is understudied; existing research appears to be narrow in scope with limited relevance to established SDM principles and the decisional needs of patients undertaking TKR surgery.

Highlights

Across healthcare, shared decision making (SDM) is increasingly considered as the preferable method of arriving at clinical decisions [1]
We focus on three key moments in the care process of patients eligible for total knee arthroplasty (TKR), suitable for SDM: (1) the decision to undergo surgery or not, (2) the decision regarding how to prepare for surgery and (3) the decision regarding how and where to recover after surgery
Both verbal and written information about TKR should be provided as part of preoperative rehabilitation

Summary

Introduction

Across healthcare, shared decision making (SDM) is increasingly considered as the preferable method of arriving at clinical decisions [1]. One of the well-established models was described by Elwyn et al (2017) [2] Elwyn and his co-authors defined SDM as a process in which decisions are made in a collaborative way, where trustworthy information about a set of options is provided to patients in an accessible format, typically in situations where the preferences, values and individual circumstances of patients and their families play a major role in decisions [2,3]. A scoping review was performed to synthesize existing scientific research regarding (1) decisional needs and preferences of patients preparing for, undergoing and recovering from TKR surgery, (2) the relation between TKR decision-support interventions and SDM elements (i.e., team talk, option talk, and decision talk), (3) the extent to which TKR decision-support interventions address patients’ decisional needs and preferences. SDM in TKR care is understudied; existing research appears to be narrow in scope with limited relevance to established SDM principles and the decisional needs of patients undertaking TKR surgery

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Discussion

Conclusion