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Hip and Knee Total Joint Arthroplasty Online Knowledge Translation Resources for Patients and Healthcare Professionals: A Canadian environmental

Background:

Despite hip and knee total joint arthroplasty (TJA) being highly performed surgeries in Canada, little is known about the available online Canadian knowledge translation (KT) tools supporting patients and healthcare professionals in this decision-making process. The aim is to identify and appraise the quality of publicly available online Canadian KT tools for patients with hip or knee osteoarthritis considering TJA and healthcare professionals participating in TJA decision-making processes. 

Methods:

An online environmental scan was conducted of Canadian governmental and healthcare association websites between May and June 2021. Two independent reviewers appraised: a) patient KT tools for supporting decision making using the International Patient Decision Aids Standards (IPDAS) criteria and for health literacy using the Patient Education Material Evaluation Tool (PEMAT) for understandability and actionability with good scores defined as ≥70; and b) healthcare professional KT tools against six appropriateness criteria for TJA (osteoarthritis symptoms negatively impact quality of life, evidence of osteoarthritis on examination, trial of conservative treatment, achievable expectations, patient and surgeon agree that potential benefits outweigh potential risks, patient is physical and mental readiness) and eight elements of shared decision making (encourage SDM, define/explain the problem, create choice awareness, encourage learning about the patient, healthcare professionals’ knowledge/recommendations, making the decision, tailoring information, deliberation). Scores of the two independent reviewers were compared and consensus was reached on disagreements. Main characteristics of KT tools for patients and healthcare professionals were descriptively synthesized and using mean, standard deviation (SD), and range. 

Results:

Of 84 included KT tools, 71 were for patients, 11 for healthcare professionals, and 2 for both. Of 73 tools for patients, 4 were patient decision aids meeting all 7 IPDAS defining criteria and the 69 other KT tools met a mean 2.4 of 7. Patient tools had mean PEMAT understandability scores of 88% (decision aids, SD 7.5, all scored ≥70%) and 78% (other KT tools, SD 13.7, 64% scored ≥70%) and mean PEMAT actionability scores of 80% (decision aids; SD 0, all scored ≥70%) and 53% (other KT tools, SD 33.0, 30% scored ≥70%). The 13 healthcare professional KT tools met a mean 2.9 of 6 TJA appropriateness criteria and a mean 2.8 of 8 shared decision making elements.

Conclusion:

Only 5% of patient KT tools were structured as a decision aid to help patients consider their options and reach a decision based on their preferences. Healthcare professional KT tools were limited to traditional criteria for determining TJA appropriateness (evidence of osteoarthritis, previous use of conservative treatments) and poorly met key elements of shared decision making. Future patient KT tools for TJA need to better support informed decision making with actionable resources, while healthcare professional KT tools need to better consider patient perspectives with elements of shared decision making.

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