I-DECIDE: Making informed decision before knee replacement
Research type
Research Study
Full title
In-DEpth Communications and Informed DEcisions (I-DECIDE): Making informed decisions before knee
IRAS ID
311955
Contact name
Rachael Gooberman-Hill
Contact email
Sponsor organisation
North Bristol NHS Trust
Duration of Study in the UK
1 years, 0 months, 29 days
Research summary
Knee replacement is a common operation that involves removing the surfaces of a damaged knee joint and replacing them with an artificial joint. Over 100,000 people in the UK have a knee replacement each year, usually to reduce pain and increase their mobility because of osteoarthritis.
Although most patients benefit from the operation, we now know that around 1 in 100 patients will have a deep infection near their artificial knee joint, around 1 in 100 will have a blood clot, and 20 in 100 will have considerable ongoing pain.
Although patients might expect some risks from surgery, our recent research suggests that many patients do not know before their operation that there is a one-in-five chance that they will have ongoing pain afterwards. While some feel that this knowledge would not change their decision to have a knee replacement, they would have felt better prepared had they known that this was a risk, and if they then have pain after surgery, they would have been more prepared about what to expect.
This project aims to understand how information about how risk is communicated before an operation. This understanding will help us to make recommendations about how to improve communication before an operation. Improved communication will help surgeons and patients to decide about the operation in a more informed way.
Our project involves three work packages:
1. Audio-recording consultations between patients and surgeons when they discuss the possibility of knee replacement.
2. Asking patients and surgeons how they would like to discuss risks, benefits and other aspects of recovery and outcomes.
3. Using these findings to help us understand how best to design a tool to help patients and professionals make decisions about knee replacement.The project will provide the information that is needed to design a future information resource that is ready for testing and use in the NHS. The research will provide benefit to:
• Patients: they will be well informed about their operation, so that expectations match current evidence and their choice to have an operation is based on this.
• Surgeons and other health professionals: they will have guidance about areas to discuss in consultations to ensure that consent is fully informed.
• NHS: the NHS can have confidence that patients and professionals work together to make the most informed choices possible.The NHS has prioritised informed choice and decision making, and this study reflects this priority along with the views of patients who have told us that they need more information when making their decision about having knee replacement. The project will benefit from patient views throughout the research through input from a patient forum of individuals who have had experience of knee replacement.
Summary of results
When doctors and patients make decisions together, like whether to have knee replacement surgery, it's important that they talk about the risks involved. Although many knee replacement operations go well, some people experience serious problems during or after their operation, and so addressing risk is an important part of making choices about knee replacement. This research study explored how risk is communicated to people with knee pain when they are making decisions about whether to have a knee replacement. To do so, the research audio-recorded 62 consultations between 16 surgeons and patients, and then carried out two focus groups with surgeons. All the audio-recorded material was typed up in full and the information was analysed to look for patterns and key themes. There were fewer focus groups than originally planned because of pressures on staff in the NHS after the COVID-19 pandemic. Around half of the patients who took part were women. We found that doctors talked about risks in different ways: some provided a list of risks, some had more detailed conversations, and some used tools to help explain. We found that patients and doctors were focused on building trust and their discussions took place in light of patients’ high levels of pain and difficulty with movement. This meant that a knee replacement often felt more like a necessity rather than an option. Efforts that emphasise care and trust are important in making decisions in situations where the treatment on offer, in this instance knee replacement, may seem like the only option.REC name
West Midlands - Solihull Research Ethics Committee
REC reference
22/WM/0058
Date of REC Opinion
15 Mar 2022
REC opinion
Further Information Favourable Opinion