Open Access Open Badges Research article

Patient, surgeon, and healthcare purchaser views on the use of decision and communication aids in orthopaedic surgery: a mixed methods study

Kevin J Bozic12*, Kate Eresian Chenok3, Jennifer Schindel4, Vanessa Chan12, James I Huddleston5, Clarence Braddock6 and Jeffrey Belkora2

Author Affiliations

1 Department of Orthopaedic Surgery, University of California, 500 Parnassus, MU 320W, San Francisco, CA 94143-0728, USA

2 Philip R. Lee Institute for Health Policy Studies, University of California, 3333 California Street, Suite 265 Box 0936, San Francisco, CA 94118, USA

3 Pacific Business Group on Health, 221 Main Street, Suite 1500, San Francisco, CA 94104, USA

4 Healthcare Research, Strategy and Design, 2423 Byron Street, Berkeley, CA 94702, USA

5 Department of Orthopaedic Surgery, Stanford University Medical Center, 450 Broadway Street, MC 6110, Redwood City, CA 94063, USA

6 David Geffen School of Medicine, University of California, 10833 Le Conte Avenue, Box 951722, 12–138 CHS, Los Angeles, CA 90095-1722, USA

For all author emails, please log on.

BMC Health Services Research 2014, 14:366  doi:10.1186/1472-6963-14-366

Published: 31 August 2014



Despite evidence that decision and communication aids are effective for enhancing the quality of preference-sensitive decisions, their adoption in the field of orthopaedic surgery has been limited. The purpose of this mixed-methods study was to evaluate the perceived value of decision and communication aids among different healthcare stakeholders.


Patients with hip or knee arthritis, orthopaedic surgeons who perform hip and knee replacement procedures, and a group of large, self-insured employers (healthcare purchasers) were surveyed regarding their views on the value of decision and communication aids in orthopaedics. Patients with hip or knee arthritis who participated in a randomized controlled trial involving decision and communication aids were asked to complete an online survey about what was most and least beneficial about each of the tools they used, the ideal mode of administration of these tools and services, and their interest in receiving comparable materials and services in the future. A subset of these patients were invited to participate in a telephone interview, where there were asked to rank and attribute a monetary value to the interventions. These interviews were analyzed using a qualitative and mixed methods analysis software. Members of the American Hip and Knee Surgeons (AAHKS) were surveyed on their perceptions and usage of decision and communication aids in orthopaedic practice. Healthcare purchasers were interviewed about their perspectives on patient-oriented decision support.


All stakeholders saw value in decision and communication aids, with the major barrier to implementation being cost. Both patients and surgeons would be willing to bear at least part of the cost of implementing these tools, while employers felt health plans should be responsible for shouldering the costs.


Decision and communication aids can be effective tools for incorporating patients preferences and values into preference-sensitive decisions in orthopaedics. Future efforts should be aimed at assessing strategies for efficient implementation of these tools into widespread orthopaedic practice.