A Scoping Review of Contextual Factors of Patient Decision Aids in Osteoarthritis

Alexa Meara¹, Karine Toupin-April², Bev Shea³, Liana Fraenkel⁴, Jennifer Barton⁵, Peter Brooks⁶, Maarten de Wit⁷ and Peter Tugwell⁸, ¹Internal Medicine/Rheumatology, The Ohio State University Wexner Medical Center, Columbus, OH, ²Children’s Hospital of Eastern Ontario Research Institute, Ottawa, ON, Canada, ³University of Ottawa, Ottawa, ON, Canada, ⁴Yale University, New Haven, CT, ⁵Oregon Health and Science University, Portland, OR, ⁶The University of Queensland, Sidney, Australia, ⁷EULAR standing committee of PARE, Zurich, Switzerland, ⁸Center For Global Health, Institute of Population Hlth, Ottawa, ON, Canada

Meeting: 2017 ACR/ARHP Annual Meeting

Date of first publication: September 18, 2017

Keywords: Decision analysis, osteoarthritis and patient assistance

Session Information

Date: Monday, November 6, 2017

Title: Patient Outcomes, Preferences, and Attitudes Poster II

Session Type: ACR Poster Session B

Session Time: 9:00AM-11:00AM

Background/Purpose: Patient decision aids (PDAs) have been developed to help patients make informed health care decisions that are consistent with their values and preferences. Patients diagnosed with osteoarthritis (OA) can choose from a wide array of treatments, such as physical therapy, exercise, medication, joint injections, and surgery (when indicated). OMERACT Filter 2.0 highlights the importance of measuring relevant contextual factors (i.e., any factors that indirectly influence the process or outcomes of interventions) in clinical studies evaluating PDAs. However, very few studies have assessed these factors. A Cochrane Systemic Review published in 2017 performed an in-depth review of benefits of PDAs and performed subgroup analyses based on the timing of the use of PDAs (i.e., before or during a consultation) but did not find any impact. The current study sought to systematically search the literature in order to appraise and summarize contextual factors that were assessed in randomized controlled trials (RCTs) of PDAs in OA.

Methods: We conducted a scoping literature review using Medline, Embase, AMED, PsycInfo and Cochrane Central from inception of the databases to June 14 2017. The search strategy was based on the Cochrane systematic review of PDAs and MeSh terms related to OA. Citations were included if they reported on RCTs evaluating PDAs compared to any control group in patients with OA.

Results: 235 citations were identified after removal of duplicates and six RCTs of PDA in OA were included. Of the six included trials, four were about the effectiveness of PDAs for knee arthroplasty and two others were for overall management of OA. Three RCTs measured PDA format as the main predictor of decision making outcomes (i.e., internet vs. DVD PDAs, and paper-based educational booklet vs. video-booklet PDA). One of these RCTs also examined the impact of patient testimonials. A fourth trial measured the setting in which the PDA was used (i.e., community or academic hospital setting) and another trial conducted subgroup analyses for patients’ characteristics. Format and content of the PDA and patients’ younger age (i.e., 50-55 years old), sex (female) and willingness to undergo surgery at baseline were linked to better decision-making outcomes.

Conclusion:

Contextual factors assessed in RCTS of PDAs in OA include format, content and setting of the PDA and patients’ characteristics. There is a need for more research to assess contextual factors in PDA RCTs in rheumatology to fulfill the OMERACT filter 2.0. Potential contextual factors to consider include the timing in which PDAs are used and the interface between the PDA and patients (e.g., tailoring to patients’ health literacy, understanding, etc). Future work will be also be needed to assess contextual factors of PDAs in other prevalent rheumatic conditions.

Disclosure: A. Meara, None; K. Toupin-April, None; B. Shea, None; L. Fraenkel, None; J. Barton, None; P. Brooks, None; M. de Wit, None; P. Tugwell, None.

To cite this abstract in AMA style:

Meara A, Toupin-April K, Shea B, Fraenkel L, Barton J, Brooks P, de Wit M, Tugwell P. A Scoping Review of Contextual Factors of Patient Decision Aids in Osteoarthritis [abstract]. Arthritis Rheumatol. 2017; 69 (suppl 10). https://acrabstracts.org/abstract/a-scoping-review-of-contextual-factors-of-patient-decision-aids-in-osteoarthritis/. Accessed .

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