Numerous studies have documented the existence of marked racial/ethnic disparities in the utilization of joint replacement in the management of osteoarthritis (OA). African-Americans (AA) are about 40 percent less likely than white patients to receive joint replacement for lower extremity OA, and this disparity is enduring based on the latest report from the CDC. Our research team published evidence demonstrating that, compared to similar white patients, AA candidates for joint replacement differ in their preferences for joint replacement and that these differences are primarily shaped by differences in knowledge and understanding about the treatment risks/benefits and expectations about surgical outcomes. Furthermore, doctor-patient communication for preference-sensitive treatments such as joint replacement is bi-directional and the content of the communication and the decisions are influenced by patient's baseline attitudes and preferences as well as their ability to engage in the discussion. There is preliminary evidence that baseline differences in preference, knowledge, and expectations regarding this treatment impact the quality of communication between AA patients and orthopaedic surgeons and consequently reduce AA patients'likelihood of receiving a recommendation for joint replacement. More research is needed to assess specific interventions to help empower AA patients in their communication with orthopaedic surgeons and improve their likelihood of receiving a recommendation for knee replacement when clinically indicated. We propose a randomized controlled trial is to assess the effect of a high-quality, evidence-based, patient-centered educational intervention supplemented with targeted counseling on the quality of communication between AA patients and orthopaedic surgeons and on the likelihood of receiving a recommendation for knee joint replacement when clinically indicated. AA patients who are potential candidates for knee joint replacement who have been referred to orthopaedic surgery will be randomized to undergo either an educational intervention using the Knee OA Decision Aid (DA) supplemented with brief counseling using the Motivational Interviewing (MI) technique or an attention control treatment. We will assess the effect of the intervention on quality of doctor- patient communication and likelihood of receiving a recommendation for knee joint replacement within 6 months of the intervention. The central hypothesis of this proposal is that orthopaedic surgeon-patient communication and decision-making about joint replacement can be improved by better informing the patients using a high quality, evidence-based, patient-centered educational intervention delivered at the time of decision-making. Therefore, the primary specific aims of this proposal are: 1) To examine the effect of the intervention on the AA patient's quality of communication with the orthopaedic surgeon, and 2) To examine the effect of the intervention on the likelihood of receiving a recommendation for knee joint replacement when clinically indicated.
Numerous studies have documented the existence of marked racial/ethnic disparities in the utilization of knee replacement, an effective and highly utilized treatment option for advanced knee osteoarthritis. This study will provide one of the first patient-centered interventions in the orthopedic setting designed to mitigate racial/ethnic disparity in access to joint replacement for patients who meet clinical indications for the treatment. The results of this study will not only inform the nation on strategies to reduce or eliminate one of most marked disparities in chronic disease management, but will also provide opportunities to improve quality of care for large segment of our society.
|Ibrahim, Said A; Blum, Marissa; Lee, Gwo-Chin et al. (2017) Effect of a Decision Aid on Access to Total Knee Replacement for Black Patients With Osteoarthritis of the Knee: A Randomized Clinical Trial. JAMA Surg 152:e164225|