Summary

Patients and doctors reported that a Decision Aid for patients with anterior cruciate ligament injuries was very useful in shared decision-making about treatment options. However, the Decision Aid did not significantly alter the proportion of patients selecting non-surgical and surgical treatments or the proportion of patients switching to surgery within the first year.

Abstract

Background

Patients with anterior crucial ligament (ACL) injury are faced with a choice between surgery or non-surgical treatment with intensive rehabilitation. To offer patients a treatment meeting their individual values, lifestyle, and conditions, patients must be involved in the decision-making. Often Decision Aids are used during the process of shared decision-making to help patients to make informed, preference-based decisions in collaboration with health professionals. Studies have indicated that Decision Aids seemed to reduce the number of surgeries in favor of more conservative options. Based on international criteria, current literature, and former patients’ experiences and suggestions, a Decision Aid for patients with ACL injury has been developed. However, the users´ experience and the impact of the Decision Aid on the proportion of patients selecting non-surgical and surgical treatments have not been investigated.
Aims
1. To investigate both patient and doctors´ experiences using the Decision Aid in Shared Decision-making.
2. To investigate whether exposure to the Decision Aid had an impact on the proportion of patients selecting non-surgical and surgical treatments and whether the exposure to the Decision Aid affected the proportion of patients switching from non-surgical to surgery treatment within the first year.

Methods

The Decision Aid was evaluated by semi-structured interviews with patients, and a focus group interview with the doctors. In a consecutive case series, proportions of patients selecting non-surgical and surgical treatments were compared before (Period: January 2015 to January 2017) and after patients` exposure to the Decision Aid (Period: January 2017 to January 2019). Data were collected retrospectively from the health records of patients with ACL injuries, who presented to the Department of Sports Traumatology in a Danish University Hospital.

Results

Both patients and doctors expressed that they found the Decision Aid very useful in shared decision-making clarifying the patients’ values concerning issues important to treatment options. Further, 1,053 patients with ACL injuries were included: 563 patients with no exposure to the Decision Aid and 490 patients with exposure to the Decision Aid. Before implementation of the Decision Aid, 27% of the patients choose non-surgical treatment and after implementation of the Decision Aid, it was 30% (p = 0.22). Before implementation of the Decision Aid, 21% of patients who initially chose non-surgical treatment, had surgery within the first year, and after implementation of the Decision Aid, it was 16%. However, the 5% reduction was not statistically significant (p = 0.26).

Conclusion

Patients and doctors reported that the Decision Aid for patients with ACL injury was very useful in clarifying the patients´ values important to treatment options. The exposure to the Decision Aid did not significantly alter the proportion of patients selecting non-surgical and surgical treatments or the proportion of patients switching to surgery within the first year.