Shared decision making (SDM) in knee osteoarthritis (OA) is essential to optimizing patient-centered care and involves clinicians and patients collaborating to make decisions using the best available evidence in combination with patients’ preferences and goals. “SDM increases patient’s knowledge of their condition, improves compliance with therapy, and can decrease the potential for decisional regret,” says Mary I. O’Connor, MD. “At its heart, SDM helps patients find the motivation they need to make positive health changes.”
SDM can engage patients with knee OA to embrace effective nonoperative therapies, Dr O’Connor adds. “To combat the epidemic of OA, immobility, obesity, and comorbidities associated with these conditions, patient engagement is crucial,” she says. By understanding patients’ values and preferences and recognizing social determinants that can impact adherence to different treatment options, SDM can optimize patient-centered outcomes in many patients with knee OA, especially for populations at greatest risk.
A Shared Decision-Making Tool
For a paper published in Orthopaedic Nursing, Dr. O’Connor, Charla B. Johnson, DNP, RN, ONC, and colleagues described the efforts of Movement is Life™, a multidisciplinary coalition that developed an SDM tool to provide a personalized framework for patient-centered discussions on knee OA treatment options. Also described is the Movement is Life™ SDM tool, which essentially personalizes the projected impact of alternative strategies on patients’ likely level of pain, activity, and economic productivity based on selected treatment choices.
“The tool uses the patient’s age, gender, race/ethnicity, self-report levels of pain and activity levels, history of comorbid conditions, education, and payer information as inputs,” explains Dr. O’Connor. “Patients and providers select one or two treatment pathways from the tool that are appropriate for the patient’s knee condition. After selecting these pathways in the tool, a visual output is produced, showing the likely outcomes of these treatments on the level of knee pain, function, and financial productivity over the next 1, 3, and 6 years. The tool also projects likely outcomes if patients do nothing.” Eight treatment pathways are divided by early- and later-stage OA, with “do nothing” serving as a comparator option (Table).
“For patients with mild to moderate knee OA, the lifestyle improvement pathway can significantly improve their knee symptoms,” says Dr. O’Connor. “However, ‘doing nothing’ results in symptom progression and increases the probability of knee replacement surgery. By personalizing this type of information to each patient, we’re taking an approach that is both unique and innovative. Patients can see the likely outcomes of their decisions, supporting an emotional connection to the desired behavior changes of weight loss and increased physical activity. For healthcare teams, the tool provides a consistent framework for critical conversations when managing patients with knee OA.”
A Catalyst for Change
The Movement is Life™ SDM tool can also help address workflow challenges when managing patients with knee OA. “With high workloads and limited resources in clinic settings, it can be challenging to allow ample time for an SDM conversation,” says Dr. Johnson. “Delegation may be the solution for providers. When nonsurgical treatment options and lifestyle modifications are recommended by providers, nurses in the clinic may be the ideal people to initiate patient centric conversations using the tool. Nurses can help patients visualize themselves in a future state, thus becoming a catalyst to behavior change and treatment adherence.”
Dr. Johnson says understanding patients’ values and preferences and exploring their social determinants of health are key to making a shared decision. “The SDM tool may help identify unspoken factors that influence health status and can be obstacles to self-management,” she says. “The healthcare team must be made aware of these barriers and then take an intentional approach when discussing these issues with patients. It’s critical to approach sensitive topics with empathy. Behavior change is difficult and requires readiness, so helping patients set realistic, ‘doable’ goals is essential. Ultimately, the Movement is Life™ SDM tool has the potential to increase autonomy, improve OA self-management, and increase confidence, knowledge, and satisfaction with treatment choices that patients make.”