Patient Decision Aid Pilotfor

Patient Decision Aid PilotFor

Osteoarthritis of the Knee

Solent NHS Trust

Pilot: May 2011 – July 2011 inclusive

Patient Group: Any patient presenting to clinical physiotherapy specialist service with known diagnosis of OA knee after establishing diagnosis of OA knee

Administration of tool: Patient information leaflet (see appendix 1) given to patient if willing to use tool on first assessment with minimal discussion on treatment options initially. Pre follow up questionnaire also given at this time (see appendix 2)

Patient completed tool and returned for post-tool debrief and use of post tool questionnaire (see appendix 3)

Overview of Outcome:

Patients generally found the tool useful. However they did find it lengthy (average length was 1-1.5 hours to complete often not including use of videos). Some younger patients did not feel they were as represented by the tool. Some were unable to re-access the tool after entering initial information which meant they did not complete it.

The majority fed back that it was very useful educationally and informative but that they found the main benefit was discussing their thoughts after using the tool with an experienced clinician to help make a decision on their care. This was reflected in the analysis of the questionnaires (below) in that questions regarding the tool itself scored well but those regarding use of tool to make a decision scored less well. The trend was towards agreement but a lot of raw results showed some ambivalence.

Overview from the questionnaire shows that they like the PDA in part one (ease of use etc.) but more variable response on its use to make decisions in the decisional conflict scale.

My recommendation is that with some adjustments it would be

an goodresource from a trusted source for patients with OA knee in the work-up to decision making about their care
Would need to be easily accessible (visible on google etc.)
It would need to be kept current and updated
An alternative media source would be needed to increase its uptake of use e.g. DVD, booklet form such as used for hip and knee school locally.
Using it at an earlier stage of the patients care (e.g. direction for use at GP/nurse led level or first point of contact clinicians) or we may implement it en-route to referral to specialist services

Participant numbers

35 people were invited to take part in using the tool over the 3 month period. 15 people declined due to lack of computer access, lack of inclination to use a computer or internet, time in spite of computers being available in department (latter part of trial) or direction to local library for help. This was generally in the older ages.

Of the 20 who agreed, 15 full data sets of questionnaires and post-tool follow up consultation have occurred to date.

Questionnaire results (only complete data sets are presented n = 15)

Part one represents the ease of use, inconsistencies and recommendation of the tool.

This was scored 1-7 with lower number being negative and higher being positive about the tool.

Question specific breakdown:

(Part One)

Average Score / Median
Satisfaction / 5.9 / 6
Simplicity / 5.9 / 6
Usefulness / 6 / 6
inconsistencies / 6.2 / 7
Expectation / 6 / 6
Need it / 4.6 / 5
Access / 5.9 / 6
Ease / 5.9 / 6
Needs / 5.7 / 6
Works / 5.8 / 6
Recommend / 6.6 / 7
Balanced / 6.6 / 7

Scoring 4 = neither agree or disagree – higher score indicate a positive response about the tool.

Part Two is generally about how it helped them prepare for the consultation

Average Score
Recognise decision / 3.8
Prepared / 3.2
Pros/cons / 3.9
Pro/cons importance / 4.1
Decision dependence / 4.2
Organise thoughts / 3.9
Involvement / 3.9
Identify questions / 4.3
Prepare to talk / 4.3

Score 3 is somewhat helped

Decisional Conflict Scale

Options available / 3.8
Benefits of Options / 3.9
Risks / 3.7
Benefits that matter / 3.7
Risks that matter / 4.1
Benefitsvs. risks / 4.1
Support for choice / 4.5
Without pressure / 4.4
Advice for choice / 3.6
Clear on best choice / 3.9
Surety about choice / 3.9
Ease of decision / 3.8
Informed choice / 3.9
Importance to self / 3.9
Sticking / 4.1
Satisfied / 4.1

Score of 4 = agree with statement about how it was to make a decision – less than indicated ambivalence (3) or disagreement (<3).

Comments

Access of tool again difficult.
Sadly I was unable to access the video links.
Very helpful in explaining the options available and what questions to ask during the consultation.
Very helpful advice given by the clinician.
As a young person with an arthritic knee the Decision Aid did not help too much as it did not offer a definitive treatment. At the time of using the Aid my knee was very painful and I had a low Oxford score but now it is better but still painful I have learnt to live with the disability. It is much more informative to talk to Jess than use the web aid.
Didn’t have enough questions relevant to a younger person and took quite a long time to complete. However, felt it gave much more information that was useful.
Jessica explained why using painkillers was important in helping my knee – this was the most useful thing
Risks section very good – made me realise surgery isn’t perfect
Found the website useful with information (although it took a long time!) but the most useful part was discussing with jess about my treatment options and timing of treatment – it made me realise that surgery was not right for me at the moment.
Referring to Part 1 question 4 – On just a few of the options it is not possible to choose a suitable response, just a point not an issue.
Oxford knee 12.
I would have liked to have seen some patient experiences from a younger patient. All the examples (video) were older people, not mum’s with children and jobs.
Younger people not that represented on the website
Is there information about half knees that can be included or whether this is a possible treatment
I decided not to think about surgery yet although had initially thought this was what I wanted. The risks put me off.

Appendix 1

Patient Decision Aid

To help you make the most appropriate decision regarding the management of your knee Osteoarthritis, a new internet based “decision aid” has been set up to assist you.

To access this, you need to type the following link into your internet browser:

To complete the decision aid you will need to scroll down the page, and click “continue” to work through the five parts of the decision aid.

This should take you approximately 15-30 minutes to complete and will aim to improve your understanding of your condition and how best to manage it.

If you do not have internet access, facilities can be arranged for you to complete the decision aid within the Physiotherapy department.

Once you have completed this we willsee you again and ask you to complete a short questionnaire and discuss your thoughts on further treatment.

Appendix 2

Pre-consultation questionnaire

Part 1 – Questions about using the Patient Decision Aid

Instructions:
Based on your experience using the Patient Decision Aid, please rate your agreement with the following statements about how you felt when using the tool.

Just circle the level of agreement that applies (where 1 means strongly disagree, 4 means neither disagree nor agree, and 7 means strongly agree; and NA means it doesn't apply).

Strongly
disagree / Neither
disagree
nor agree / Strongly agree
1. I am satisfied with it. / 1------2------3------4------5------6------7 / NA
2. It is simple to use. / 1------2------3------4------5------6------7 / NA
3. It is useful. / 1------2------3------4------5------6------7 / NA
4. I didn't notice any inconsistencies as I use it. / 1------2------3------4------5------6------7 / NA
5. It does everything I would expect it to do. / 1------2------3------4------5------6------7 / NA
6. I feel I need to have it. / 1------2------3------4------5------6------7 / NA
7. I could access it successfully every time. / 1------2------3------4------5------6------7 / NA
8. I could use it without written instructions. / 1------2------3------4------5------6------7 / NA
9. It meets my needs. / 1------2------3------4------5------6------7 / NA
10. It works the way I want it to work. / 1------2------3------4------5------6------7 / NA
11. I would recommend it to someone with a similar condition. / 1------2------3------4------5------6------7 / NA
12. It presents information in a balanced manner? (Shows the positive and negative features with equal detail) / 1------2------3------4------5------6------7 / NA

Any additional comments:

Part 2 – Questions about how the Decision Aid helped you to prepare for your consultation

Not at all / A little / Somewhat / Quite a bit / A great deal
Did the patient decision aid….

Help you recognise that a decision needs to be made

/ 1 / 2 / 3 / 4 / 5

Prepare you to make a better decision

/ 1 / 2 / 3 / 4 / 5

Help you think about the pros and cons of each option

/ 1 / 2 / 3 / 4 / 5

Help you think about which pros and cons are most important

/ 1 / 2 / 3 / 4 / 5

Help you know that the decision depends on what matters most to you

/ 1 / 2 / 3 / 4 / 5

Help you organise your own thoughts about the decision

/ 1 / 2 / 3 / 4 / 5

Help you think about how involved you want to be in the decision

/ 1 / 2 / 3 / 4 / 5

Help you identify questions you want to ask the clinician

/ 1 / 2 / 3 / 4 / 5

Prepare you to talk to the clinician about what matters most to you

/ 1 / 2 / 3 / 4 / 5

Based on: ID Graham & Am O’Connor, User Manual – Preparation for Decision Making 1995 [updated 2010]. Available from

Any additional comments:

Appendix 3

Strongly Agree / Agree / Neither Agree or Disagree / Disagree / Strongly Disagree

+ Add Question▼

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Q14

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14.My decision shows what is important to me

Strongly Agree / Agree / Neither Agree or Disagree / Disagree / Strongly Disagree

+ Add Question▼

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Q15

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15.I expect to stick with my decision

Strongly Agree / Agree / Neither Agree or Disagree / Disagree / Strongly Disagree

+ Add Question▼

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Q16

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16.I am satisfied with my decision

Strongly Agree / Agree / Neither Agree or Disagree / Disagree / Strongly Disagree

+ Add Question▼

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Q17

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17.Please provide any additional comments

RAW DATA

Part 1 / 1 / 5 / 6 / 6 / 7 / 5 / 7 / 6 / 6 / 7 / 5 / 4 / 7 / 7 / 5 / 6
2 / 6 / 5 / 6 / 7 / 6 / 7 / 7 / 6 / 7 / 5 / 2 / 6 / 7 / 6 / 6
3 / 6 / 5 / 7 / 7 / 3 / 6 / 6 / 6 / 7 / 5 / 6 / 7 / 7 / 6 / 6
4 / 6 / 6 / 7 / 7 / 7 / 7 / 7 / 7 / 7 / 5 / 2 / 5.5 / 7 / 6 / 6
5 / 6 / 6 / 7 / 7 / 4 / 6 / 6 / 7 / 7 / 5 / 4 / 6 / 7 / 6 / 6
6 / 1 / 2 / 7 / 7 / 1 / 5 / 4 / 5 / 7 / 4 / 5 / 6.5 / 4 / 5 / 6
7 / 6 / 1 / 6 / 6 / 7 / 7 / 7 / 7 / 7 / 6 / 4 / 6 / 7 / 6 / 6
8 / 6 / 6 / 4 / 6 / 7 / 7 / 7 / 7 / 7 / 6 / 1 / 6 / 7 / 6 / 6
9 / 6 / 6 / 7 / 6 / 4 / 6 / 7 / 6 / 7 / 4 / 2 / 6.5 / 7 / 5 / 6
10 / 6 / 6 / 7 / 6 / 5 / 6 / 6 / 6 / 7 / 4 / 4 / 6 / 7 / 5 / 6
11 / 6 / 6 / 7 / 7 / 7 / 7 / 7 / 7 / 7 / 6 / 6 / 7 / 7 / 6 / 6
12 / 7 / 6 / 7 / 7 / 7 / 7 / 7 / 7 / 7 / 6 / 5 / 6.5 / 7 / 6 / 6
Comments
Part 2 / 1 / 4 / 4 / 4 / 4 / 1 / 5 / 4 / 4 / 5 / 4 / 3 / 3 / 5 / 4 / 3
2 / 3 / 1 / 5 / 4 / 3 / 4 / 3 / 4 / 2 / 2 / 3 / 4 / 4 / 3 / 3
3 / 3 / 1 / 5 / 4 / 3 / 5 / 4 / 5 / 5 / 5 / 4 / 4 / 4 / 4 / 2
4 / 4 / 4 / 5 / 4 / 4 / 5 / 3 / 4 / 5 / 5 / 4 / 4 / 4 / 4 / 3
5 / 3 / 4 / 5 / 4 / 5 / 4 / 5 / 4 / 5 / 4 / 5 / 3 / 5 / 4 / 3
6 / 4 / 4 / 5 / 4 / 3 / 4 / 4 / 3 / 5 / 4 / 4 / 4 / 5 / 4 / 2
7 / 4 / 4 / 5 / 4 / 1 / 5 / 5 / 4 / 5 / 4 / 4 / 2 / 5 / 4 / 3
8 / 5 / 4 / 5 / 4 / 4 / 5 / 5 / 4 / 4 / 4 / 4 / 3 / 5 / 4 / 5
9 / 4 / 4 / 5 / 4 / 4 / 5 / 5 / 4 / 4 / 4 / 4 / 4 / 4 / 5 / 4
Comments
DCS / 1 / 4 / 4 / 3 / 4 / 4 / 4 / 5 / 4 / 3 / 3 / 4 / 3 / 4 / 5 / 3
2 / 4 / 4 / 4 / 4 / 3 / 5 / 4 / 4 / 4 / 4 / 4 / 3 / 4 / 5 / 3
3 / 4 / 4 / 4 / 3 / 2 / 4 / 3 / 4 / 3 / 4 / 4 / 4 / 5 / 5 / 2
4 / 4 / 4 / 4 / 3 / 3 / 4 / 4 / 3 / 3 / 4 / 4 / 4 / 4 / 5 / 2
5 / 4 / 4 / 4 / 5 / 4 / 5 / 5 / 5 / 4 / 3 / 3 / 4 / 4 / 5 / 2
6 / 5 / 4 / 5 / 4 / 3 / 4 / 5 / 4 / 4 / 4 / 4 / 4 / 4 / 5 / 2
7 / 4 / 4 / 5 / 4 / 5 / 5 / 5 / 5 / 4 / 5 / 5 / 4 / 5 / 5 / 3
8 / 5 / 4 / 5 / 5 / 5 / 5 / 5 / 4 / 4 / 5 / 4 / 3 / 4 / 5 / 3
9 / 4 / 4 / 5 / 5 / 4 / 4 / 5 / 4 / 3 / 3 / 2 / 3 / 2 / 3 / 3
10 / 4 / 4 / 4 / 5 / 3 / 5 / 4 / 5 / 3 / 5 / 4 / 2 / 4 / 5 / 2
11 / 4 / 4 / 4 / 4 / 3 / 5 / 5 / 4 / 3 / 5 / 2 / 3 / 5 / 5 / 2
12 / 4 / 4 / 4 / 5 / 2 / 5 / 4 / 4 / 3 / 5 / 2 / 3 / 5 / 5 / 2
13 / 4 / 4 / 4 / 5 / 4 / 5 / 4 / 4 / 3 / 5 / 2 / 3 / 4 / 5 / 3
14 / 4 / 4 / 5 / 5 / 4 / 4 / 4 / 4 / 3 / 5 / 2 / 3 / 4 / 5 / 3
15 / 4 / 4 / 5 / 5 / 3 / 5 / 5 / 4 / 4 / 4 / 2 / 3 / 5 / 5 / 3
16 / 4 / 4 / 5 / 5 / 4 / 4 / 5 / 4 / 4 / 5 / 2 / 3 / 5 / 5 / 3
(DCS 5 = Strongly Agree, 1 = Strongly Disagree)
Comments