• Karen Sepucha, Sandra Feibelmann, Yuchiao Chang, Catharine F Clay, Stephen A Kearing, Ivan Tomek, Theresa Yang, and Jeffrey N Katz.
• Division of General Internal Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA. Electronic address: ksepucha@partners.org.
• J. Am. Coll. Surg.. 2013 Oct 1;217(4):694-701.

BackgroundShared decision making requires informing patients and ensuring that treatment decisions reflect their goals. It is not clear to what extent this happens for patients considering total joint replacement (TJR) for hip or knee osteoarthritis.Study DesignWe conducted a cross-sectional mail survey of osteoarthritis patients at 4 sites, who made a decision about TJR. The survey measured knowledge and goals, the decision making process, decision confidence, and decision regret. Decision quality was defined as the percentage of patients who had high knowledge scores and received treatments that matched their goals. Multivariable regression models examined factors associated with knowledge and decision quality.ResultsThere were 382 patients who participated (78.6% response rate). Mean knowledge score was 61% (SD 20.7%). In multivariate linear regression, higher education, having TJR, and site were associated with higher knowledge. Many patients (73%) received treatments that matched their goals. Thirty-one percent of patients met our definition for high decision quality. Higher decision making process scores, higher quality of life scores, and site were associated with higher decision quality. Patients who had high decision quality had less regret (73.1% vs 58.5%, p = 0.007) and greater confidence (9.0 [SD 1.6] vs 8.2 [SD 2.3] out of 10, p < 0.001).ConclusionsA third of patients who recently made a decision about osteoarthritis treatment met both criteria for a high quality decision. Controlling for treatment, patients reporting more involvement in the decision making process, higher quality of life, and being seen at a site that uses decision aids were associated with higher decision quality.Copyright © 2013 American College of Surgeons. Published by Elsevier Inc. All rights reserved.

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