Background/Purpose: Knee osteoarthritis (KOA) is the most common form of mobility disability in the United States yet those at highest risk—older adults with overweight and obesity— continue to have unmet needs regarding their KOA care.  People with early KOA receive arthroscopic surgery proven to have no benefit and receive little information regarding exercise and weight loss that may modify the course of their disease.  Although shared decision making (SDM) and decision aids (DAs) are effective strategies to reduce unnecessary procedures by guiding patients to make informed decisions incorporating their personal values, SDM and DAs are not widely used. To our knowledge, studies have not simultaneously compared patient and provider preferences of multiple decision making tools in early KOA.  Our study examines three DAs for early KOA: (1) Osteoarthritis Option Grids, (2) the “Managing Early-Stage Knee Osteoarthritis” booklet, and (3) “What are my options for managing hip or knee osteoarthritis?: A stepped decision aid.”  Evaluating DA preferences of both patients and providers will serve as a first step to build and implement a system of effective early KOA care that supports lifestyle modification for older adults who are overweight or obese.

Methods: This on-going study employs a cross-sectional, qualitative design using focus groups of patients and providers.  We recruit English-speaking participants by flier, word of mouth, and referral. The patient group (n=35) inclusion criteria are: a) Body Mass Index =/>25 kg/m²; b) age =/> 60 years, and; c) the diagnosis of KOA or a positive screen for knee OA on The Knee and Hip OA Screening Questionnaire. The provider group (n=35) is recruited through word of mouth and by email invitation. Providers that care for adults with OA in an academic or community setting are included. Plan is for five focus groups per target population, or until thematic saturation is reached. Each group uses a semi-structured format and lasts 60 to 90 minutes. The taped sessions are de-identified by a transcriptionist.  Transcripts are coded and for the generation of themes by two researchers using a qualitative data analysis software program.

Results: Preliminary results from patient focus groups conducted during May 2013 show emerging themes include costs of care, lack of information about treatment options, and challenges in communicating with providers. Patients demonstrated an interest in SDM and DAs, but had little prior exposure to the tools. They also commented on the granularity and visual presentation of evidence, the lack of details regarding exercise options available, and the logistics of distributing DAs.  Participants were enthusiastic about shared medical appointments. Patients gravitated towards the booklet format, but appreciated the unique characteristics of all the decision aids. They felt the DA’s would be useful before, during, and after a clinic appointment and would assist with provider communication.

Conclusion: Preliminary results indicate that patients respond to a variety of early KOA decision aids and are eager to engage providers in shared decision making.  Patients are concerned about costs of care, a theme not incorporated into any of the decision aids.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/shared-decision-making-in-early-knee-osteoarthritis-perspectives-of-older-adults-with-overweight-and-obesity-and-health-care-providers/