A mixed methods of the acceptability and implementation potential of a novel Shared Decision-Making tool for Knee Osteoarthritis.


BNSSG ICB Research Capability Funding­­.

What is the problem?

Osteoarthritis of the knee is a chronic condition that can cause severe pain and disability. Every year 10% of UK adults seek help for osteoarthritis, with nearly 100,000 patients receiving knee replacements for osteoarthritis within the NHS.

Treatment guidelines for osteoarthritis recommend information, education, exercise, physiotherapy, weight-loss, and medication before knee replacement surgery. However, there are concerns that total knee replacement surgery (TKR) is overused, evidenced by inappropriate referrals, inequity in access to surgery, and that uptake of the most strongly recommended non-surgical treatments (weight loss and exercise) is lower than referral rates for TKR. Evidence indicates that clinicians do not have time to provide up-to-date information on alternatives to surgery, or to address patient values and preferences for treatment.

Shared Decision Making (SDM) ensures that patients make more informed choices about their care, while inequalities are reduced, and healthcare resources are optimised. This is very important for knee osteoarthritis where evidence shows that there is a real lack of SDM.

What is the aim of the research?

The Torbay Knee chart-BNSSG edition Shared Decision Aid has been developed to ensure that patients have access to appropriate treatments at every stage of the disease process. The tool aims to ensure that patients and clinicians are supported to make a more informed choice about treatment options and to improve patient-centred care planning.

This research aims to establish the tools acceptability to users; its adaptation from one healthcare context to another and its implementation potential within current local systems.

How will this be achieved?

We will conduct interviews with patients and clinicians to explore expectations of SDM and the acceptability of the decision aid; to what extent it was used as intended, barriers to use, mitigating factors and suggestions for further refinement, as well as experience of the shared decision-making process. We will also ask for clinicians’ views on whether the current system supports the effective use of the tool.

Interviews with CCG commissioners involved in the implementation of the Avon Knee Decision Aid aim to understand their perspectives on its adoption, implementation, and challenges.

Findings will be fed back to stakeholders so that learning from the study can be used to refine the tool if required. We will also establish links with Population Health Management to use the System Wide Data sets. This is essential for future research, to establish what impact the decision aid has on access to services and whether the introduction of the decision aid will result in any shift in use of services. This would help to determine in a future study, how the tool is being delivered at what point on the MSK pathway (primary, secondary care, elective) with whom (patient information including age, sex, ethnicity, disease severity, BMI, co-morbidity, and social deprivation), and which services patients go on to engage with, and at what cost.

Who is leading the research?

Dr Andrew Moore, Senior Lecturer in Musculoskeletal Health Service Research, Musculoskeletal Research Unit, Bristol Medical School.

Further information

About Dr Andrew Moore

For more information or to get involved with this project, please contact bnssg.research@nhs.net.