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Improving Informed Decision-Making for Patients with Knee Pain

LIANA FRAENKEL, NICOLE RABIDOU, DICK WITTINK, and TERRI FRIED

ABSTRACT.

Objective. Studies have shown that patients with knee pain are not well informed of their potential treatment options and that patient preferences are often discordant with physician practices. The objective of this pilot study was to test the efficacy of a computer tool to improve informed decision-making for patients with knee pain in an outpatient primary care clinic setting.

Methods. Patients with knee pain were randomized to receive an information pamphlet or to perform a computer task. The latter was designed to elicit preferences based on patient tradeoffs for route of administration, benefits, and side effects of commonly used treatment options for knee pain. After performing the task, participants were given a printed handout illustrating their preferences.

Results. In total, 87 patients were randomized. Decisional self-efficacy, preparedness to participate in decision-making, and arthritis self-efficacy were greater in participants randomized to the intervention arm compared to those receiving the information pamphlet (p < 0.05 for all comparisons).

Conclusion. Participants using a tool designed to increase patient awareness of choice and evaluate the tradeoffs related to available treatment options were more confident in their ability to obtain information about available treatment options, were better prepared to participate in their visit, and had better arthritis related self-efficacy compared to patients receiving an information pamphlet. The results of this pilot study justify future large-scale trials to determine the effectiveness of similar interventions. (First Release August 1 2007; J Rheumatol 2007;34:1894-8)

Key Indexing Terms:

DECISION-MAKING
PATIENTS
KNEE PAIN
COMPUTER-ASSISTED INSTRUCTION

From the Veterans Affairs Connecticut Healthcare System and the Yale University School of Medicine, New Haven, Connecticut, USA.

Supported in part by a grant from the Claude D. Pepper Older Americans Independence Center at Yale University School of Medicine (P30AG21342). Dr. Fraenkel is supported by the K23 Award AR048826-01 A1.

L. Fraenkel, MD, MPH, Associate Professor of Medicine; T. Fried, MD, Associate Professor of Medicine, Veterans Affairs Connecticut Healthcare System, Yale University School of Medicine; N. Rabidou, MD, MPH, Fellow, Section of Rheumatology, Yale University School of Medicine; D. Wittink, PhD, Professor of Marketing, Yale University.

Dr. Wittink is deceased.

Address reprint requests to Dr. L. Fraenkel, Section of Rheumatology, Yale University School of Medicine, 300 Cedar St., TAC 525, PO Box 208031, New Haven, CT 06520-8031. E-mail: liana.fraenkel@yale.edu

Accepted for publication April 27, 2007.