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How outcome prediction could affect patient decision making in knee replacements : a qualitative study

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Barlow, Timothy, Scott, Patricia, Griffin, Damian R. and Realpe, Alba (2016) How outcome prediction could affect patient decision making in knee replacements : a qualitative study. BMC Musculoskeletal Disorders, 17 . 304. doi:10.1186/s12891-016-1165-x

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Official URL: https://doi.org/10.1186/s12891-016-1165-x

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Abstract

Background

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.

Methods

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.

Results

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.

Conclusion

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.

Item Type: Journal Article
Subjects: R Medicine > RD Surgery
Divisions: Faculty of Medicine > Warwick Medical School > Health Sciences > Clinical Trials Unit
Faculty of Medicine > Warwick Medical School > Health Sciences
Faculty of Medicine > Warwick Medical School
Library of Congress Subject Headings (LCSH): Total knee replacement -- Patients, Clinical medicine -- Decision making
Journal or Publication Title: BMC Musculoskeletal Disorders
Publisher: Biomed central
ISSN: 1471-2474
Official Date: 22 July 2016
Dates:
DateEvent
22 July 2016Published
12 July 2016Accepted
Volume: 17
Article Number: 304
DOI: 10.1186/s12891-016-1165-x
Status: Peer Reviewed
Publication Status: Published
Access rights to Published version: Open Access
RIOXX Funder/Project Grant:
Project/Grant IDRIOXX Funder NameFunder ID
UNSPECIFIEDArthritis Research UKUNSPECIFIED

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