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195 Empowering choices: a journey into influencing factors for patients and surgeons in designing patient decision aids for hip and knee osteoarthritis
  1. Trine A Pedersen1,2,
  2. Charlotte M Jensen3,4,
  3. Martin Lindberg-Larsen3,4,
  4. Claus Varnum1,2,
  5. Karina D Steffensen2,5
  1. 1Department of Orthopaedic Surgery, Lillebaelt Hospital, University Hospital of Southern Denmark, Vejle, Denmark
  2. 2Department of Regional Health Research, University of Southern Denmark, Odense, Denmark
  3. 3Orthopaedic Research Unit, Clinical Institute, University of Southern Denmark, Denmark
  4. 4Department of Orthopaedic Surgery, Odense University Hospital, Odense, Denmark
  5. 5Center for Shared Decision Making, Lillebaelt Hospital, University Hospital of Southern Denmark, Vejle, Denmark

Abstract

Introduction Navigating the numerous surgical or non-surgical options for treating osteoarthritis (OA), poses a significant challenge for patients. Determining the optimal course of action involves weighing potential benefits associated with each option. Furthermore, the definition of ‘best treatment is often subjective, influenced by individual circumstances and personal preferences.

While Patient Decision Aids (PtDAs) has, proven valuable in helping patients and clinicians clarify values and choosing the most suitable treatment, their integration into orthopaedic consultations remains limited. This study aims to identify the key decision-making factors relevant to patients and surgeons in the context of hip and knee OA.

Methods Fifteen field observations, inspired by the ’Observing Patient Instrument (OPTION5)’ and four focus group discussions were conducted. Two with patients (n=11) and relatives (n=4), as well as two with orthopaedic surgeons (n=12). Data was analysed through thematic analysis.

Results Field observations revealed consultation practice variations, information disclosure, and patient-surgeon dynamics. The focus group discussions identified eight main themes influencing Shared Decision- Making (SDM). Patient-derived themes emphasized the importance of weighing treatment options, considering quality of life, being involved in the decision, and highlighted the key role of the patient- surgeon relationship in building confidence.

Conversely, surgeons expressed scepticism about PtDAs, citing concerns about individual practices, information-sharing habits, and a potential imbalance in -patient responsibility in decision-making. Apprehensions also surfaced about discrepancies between patient preferences and surgeons’ professional knowledge.

Discussion All participants advocated for patient-centred approaches, recognizing individual preferences and acknowledging the importance of the patient-surgeon relationship. By introducing SDM, the surgeons expressed well-known scepticism concerning the patients‘ responsibility in the SDM process.

Conclusion This study explores the intricate interaction between OA patients and surgeons during the decision- making process, illuminating the complex dynamics that influence SDM in orthopaedic settings.

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