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Development and validation of a decision aid for shared decision making for ACL injured patients
Author(s):
Frandsen Lone (Denmark)
,
Frandsen Lone (Denmark)
Affiliations:
Mainz Hanne
,
Mainz Hanne
Affiliations:
Fauno P.
,
Fauno P.
Affiliations:
Lind M.
Lind M.
Affiliations:
ESSKA Academy. Frandsen L. 05/09/18; 209357; P04-1208
Lone Frandsen
Lone Frandsen
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Abstract
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Objectives: Shared decision making (SDM) is a present focus for modern health care. Decision aids (DA) are tools designed to facilitate SDM. For patients with anterior cruciate ligament injury the choice between surgical and non-surgical treatment can be difficult with recent scientific evidence for good clinical outcome for both treatment principles. This emphasizes the need for a validated DA to help patients to take a qualified decision in their choice of treatment.
The aim of this study is therefore to develop and test a DA for patients choosing between surgical or non-surgical treatment after ACL injury.

Methods: Key issues necessary for informed patient treatment decision after ACL injury were identified through questionnaires and interview of patients and surgeons. A 30-point questionnaire was initially developed by input from patients, surgeons, nurses and physiotherapist. 27 ACL injured patients prioritized the points of importance for their ability to support treatment decision-making. 37 ACL injured patients participated in semi-structured interview focused on information needs for treatment decision. Based on questionnaire and interview responses key information themes where identified. Evidence based knowledge for each theme was identified for surgical and non-surgical treatment through literature search. A DA could then been created in the form of an "option grid" with the identified and prioritized themes and corresponding evidence related to treatments. To evaluate the patient and surgeon experience of the usage of option grid the DA was used for all ACL injured patient over a six month period. Experiences with DA usage were evaluated qualitatively.

Results: The following information themes of patient importance were identified: 1. Knee stability, 2. Possible activities of daily living, 3. Sport ability, 4. Work ability, 5. Clinical results, 6. Risks 7. Rehabilitation, 8. Sick leave. A two page option grid was created containing information relating to surgical and non-surgical ACL injury treatment for all eight themes.
The surgeons experienced that the option grid helped them giving systematic information about treatment options and consequences after ACL injury. The patients experienced that they were involved in the treatment decision process and that they were better informed for taking the treatment decision that was right for their situation and needs.

Conclusions: An option grid type DA for SDM could be created with patient identified information needed for treatment decision after ACL injury. Implementation of this DA resulted in increased experience of SDM for patients with ACL injury. Future studies will demonstrate to what degree SDM are increased and to what degree SDM changes the treatments given for ACL injury.

Keywords:
Shared decision making, ACL injury, Treatment, Option grid
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