Open Access Study protocol

Option Grids to facilitate shared decision making for patients with Osteoarthritis of the knee: protocol for a single site, efficacy trial

Katy Marrin1, Fiona Wood1*, Jill Firth2, Katharine Kinsey2, Adrian Edwards1, Kate E Brain1, Robert G Newcombe1, Alan Nye2, Timothy Pickles3, Kamila Hawthorne1 and Glyn Elwyn4

Author Affiliations

1 Cochrane Institute of Primary Care and Public Health, School of Medicine, Cardiff University, Neuadd Meirionnydd, Heath Park, CF14 4YS Cardiff, UK

2 Pennine MSK Partnership Ltd, Integrated Care Centre, New Radcliffe Street, Oldham OL1 1NL, UK

3 South East Wales Trials Unit, School of Medicine, Cardiff University, Neuadd Meirionnydd, Heath Park, Cardiff CF14 4YS, UK

4 The Dartmouth Center for Health Care Delivery Science, Dewey Field Road, Hanover, NH 03755, USA

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BMC Health Services Research 2014, 14:160  doi:10.1186/1472-6963-14-160

Published: 7 April 2014

Abstract

Background

Despite policy interest, an ethical imperative, and evidence of the benefits of patient decision support tools, the adoption of shared decision making (SDM) in day-to-day clinical practice remains slow and is inhibited by barriers that include culture and attitudes; resources and time pressures. Patient decision support tools often require high levels of health and computer literacy. Option Grids are one-page evidence-based summaries of the available condition-specific treatment options, listing patients’ frequently asked questions. They are designed to be sufficiently brief and accessible enough to support a better dialogue between patients and clinicians during routine consultations. This paper describes a study to assess whether an Option Grid for osteoarthritis of the knee (OA of the knee) facilitates SDM, and explores the use of Option Grids by patients disadvantaged by language or poor health literacy.

Methods/Design

This will be a stepped wedge exploratory trial involving 72 patients with OA of the knee referred from primary medical care to a specialist musculoskeletal service in Oldham. Six physiotherapists will sequentially join the trial and consult with six patients using usual care procedures. After a period of brief training in using the Option Grid, the same six physiotherapists will consult with six further patients using an Option Grid in the consultation. The primary outcome will be efficacy of the Option Grid in facilitating SDM as measured by observational scores using the OPTION scale. Comparisons will be made between patients who have received the Option Grid and those who received usual care. A Decision Quality Measure (DQM) will assess quality of decision making. The health literacy of patients will be measured using the REALM-R instrument. Consultations will be observed and audio-recorded. Interviews will be conducted with the physiotherapists, patients and any interpreters present to explore their views of using the Option Grid.

Discussion

Option Grids offer a potential solution to the barriers to implementing traditional decision aids into routine clinical practice. The study will assess whether Option Grids can facilitate SDM in day-to-day clinical practice and explore their use with patients disadvantaged by language or poor health literacy.

Trial registration

Current Controlled Trials ISRCTN94871417

Keywords:
Shared decision making; Decision aids; Osteoarthritis of the knee; Arthritis; Health literacy; Patient communication