African American Preference for Knee Replacement: A Patient-Centered Intervention
| Status: | Active, not recruiting |
|---|---|
| Conditions: | Arthritis, Osteoarthritis (OA) |
| Therapuetic Areas: | Rheumatology |
| Healthy: | No |
| Age Range: | 50 - Any |
| Updated: | 3/30/2019 |
| Start Date: | July 2010 |
| End Date: | July 8, 2019 |
Behavioral & Social Science Research on Understanding and Reducing Health Disparities
A randomized, controlled design will be utilized to examine and compare the effectiveness of
the proposed educational intervention, which includes an educational decision aid with
attention control on select key patient-centered and process of care outcomes. The study
sample will consist of approximately 300 African-American patients with osteoarthritis (OA)
of the knee. Patients will be recruited from Pennsylvania Presbyterian Medical Center and the
Philadelphia VA Medical Center and will be randomized to one of the two study arms.
The immediate goal of this randomized controlled trial is to assess the effect of a
high-quality, evidence-based, patient-centered educational intervention on African American
patient preferences, expectations, and the likelihood of receiving a recommendation for knee
joint replacement surgery when clinically indicated. The long-term goal of this research is
to implement effective strategies to improve minority patients' access to joint replacement
and ultimately eliminate racial disparities in the utilization of this effective treatment
for knee OA.
Study Aim: To examine the effect of the decision aid (DA) intervention on the likelihood of
receiving a recommendation for knee joint replacement when clinically indicated. Hypothesis:
The DA intervention will lead to higher rate of treatment recommendation within 6 months.
Secondary Aim: To examine the effect of the DA intervention on the rate of knee replacement
receipt within 12 months. Hypothesis: Patients randomized to receive the intervention will
undergo knee replacement within 12 months at a higher rate than those in the attention
control group.
the proposed educational intervention, which includes an educational decision aid with
attention control on select key patient-centered and process of care outcomes. The study
sample will consist of approximately 300 African-American patients with osteoarthritis (OA)
of the knee. Patients will be recruited from Pennsylvania Presbyterian Medical Center and the
Philadelphia VA Medical Center and will be randomized to one of the two study arms.
The immediate goal of this randomized controlled trial is to assess the effect of a
high-quality, evidence-based, patient-centered educational intervention on African American
patient preferences, expectations, and the likelihood of receiving a recommendation for knee
joint replacement surgery when clinically indicated. The long-term goal of this research is
to implement effective strategies to improve minority patients' access to joint replacement
and ultimately eliminate racial disparities in the utilization of this effective treatment
for knee OA.
Study Aim: To examine the effect of the decision aid (DA) intervention on the likelihood of
receiving a recommendation for knee joint replacement when clinically indicated. Hypothesis:
The DA intervention will lead to higher rate of treatment recommendation within 6 months.
Secondary Aim: To examine the effect of the DA intervention on the rate of knee replacement
receipt within 12 months. Hypothesis: Patients randomized to receive the intervention will
undergo knee replacement within 12 months at a higher rate than those in the attention
control group.
The study involves a baseline questionnaire, educational intervention, and follow-up
questionnaire by phone 12 months after the intervention takes place. All eligible, consented
patients will complete the baseline questionnaire, conducted by an ACTION research staff
member. The baseline questionnaire (attached at end of protocol) will include the following
instruments that have been field-tested by our team in previous and ongoing studies: 1.)
Willingness to Consider Joint Replacement Question 2.)Knowledge Regarding Knee OA and Joint
Replacement (developed by The Foundation for Informed Medical Decision Making) 3.) Hospital
for Special Surgery Knee Expectations Survey 4.)Socioeconomic Survey 5.) Access to Health
Care, Charleson Comorbidity Index 6.) Quality of Life SF-12v2. This survey can be done over
the phone or in person. It should take approximately 30-40 minutes. At the completion of the
baseline questionnaire, patients will be randomized into either study Decision Aid (DA)
(hereafter referred to as DA intervention) arm or the attention control arm. Patient
appointments for the DA intervention or attention control activity will be scheduled to occur
2 weeks prior to the patients appointment with an orthopedic specialist (up to the date of
the appointment). The DA intervention (referred to as an information session in patient
material) will be completed by an ACTION research study interventionist (the interventionist
will not administer the baseline assessment). In the intervention arm, patients will be shown
a decision aid video entitled, Treatment Choices for Knee Osteoarthritis. The patients are
then given a brief education intervention called AskMe3, which is a brief communication
skill-building intervention developed by the Partnership for Clear Health Communication.
AskMe3 instructs patients 3 questions to ask their doctor: a) what is my main problem b) what
do I need to do c) why is it important for me to do this? The completion time for the
educational intervention will be approximately 1 hour. The attention control arm will be
conducted by the ACTION research staff. Patients will be given written educational material
adapted from the NIH/NIAMS publication Osteoarthritis to review at his/her leisure. (A copy
of the information contained in the informational pamphlet is attached at end of protocol).
The completion time for the attention control arm is approximately 10 minutes. Follow-up
procedures will occur at the following time points: 1.) approximately 6 months after the
participants intervention, an ACTION team staff member will review their medical chart to see
if the participant had knee joint replacement surgery 2.)12-months post intervention
participants will be contacted to find out if they had knee joint replacement surgery and a
medical chart assessment will occur at this time as well. All follow-up procedures will be
administered by an ACTION research team member that was not involved in the educational
intervention. Participants in both the DA intervention and the attention control will
complete a 12-month follow-up (completed approximately 12 months post intervention)survey
over the phone. The survey will be comprised of the following: Willingness to consider joint
replacement, Hospital for Special Surgery Knee Expectations Survey, Knowledge Regarding Knee
OA and Joint Replacement, and a survey regarding surgery for joint replacement. At the time
of the 12-month follow-up, the patient's medical record will be accessed to check for a joint
replacement procedure.
questionnaire by phone 12 months after the intervention takes place. All eligible, consented
patients will complete the baseline questionnaire, conducted by an ACTION research staff
member. The baseline questionnaire (attached at end of protocol) will include the following
instruments that have been field-tested by our team in previous and ongoing studies: 1.)
Willingness to Consider Joint Replacement Question 2.)Knowledge Regarding Knee OA and Joint
Replacement (developed by The Foundation for Informed Medical Decision Making) 3.) Hospital
for Special Surgery Knee Expectations Survey 4.)Socioeconomic Survey 5.) Access to Health
Care, Charleson Comorbidity Index 6.) Quality of Life SF-12v2. This survey can be done over
the phone or in person. It should take approximately 30-40 minutes. At the completion of the
baseline questionnaire, patients will be randomized into either study Decision Aid (DA)
(hereafter referred to as DA intervention) arm or the attention control arm. Patient
appointments for the DA intervention or attention control activity will be scheduled to occur
2 weeks prior to the patients appointment with an orthopedic specialist (up to the date of
the appointment). The DA intervention (referred to as an information session in patient
material) will be completed by an ACTION research study interventionist (the interventionist
will not administer the baseline assessment). In the intervention arm, patients will be shown
a decision aid video entitled, Treatment Choices for Knee Osteoarthritis. The patients are
then given a brief education intervention called AskMe3, which is a brief communication
skill-building intervention developed by the Partnership for Clear Health Communication.
AskMe3 instructs patients 3 questions to ask their doctor: a) what is my main problem b) what
do I need to do c) why is it important for me to do this? The completion time for the
educational intervention will be approximately 1 hour. The attention control arm will be
conducted by the ACTION research staff. Patients will be given written educational material
adapted from the NIH/NIAMS publication Osteoarthritis to review at his/her leisure. (A copy
of the information contained in the informational pamphlet is attached at end of protocol).
The completion time for the attention control arm is approximately 10 minutes. Follow-up
procedures will occur at the following time points: 1.) approximately 6 months after the
participants intervention, an ACTION team staff member will review their medical chart to see
if the participant had knee joint replacement surgery 2.)12-months post intervention
participants will be contacted to find out if they had knee joint replacement surgery and a
medical chart assessment will occur at this time as well. All follow-up procedures will be
administered by an ACTION research team member that was not involved in the educational
intervention. Participants in both the DA intervention and the attention control will
complete a 12-month follow-up (completed approximately 12 months post intervention)survey
over the phone. The survey will be comprised of the following: Willingness to consider joint
replacement, Hospital for Special Surgery Knee Expectations Survey, Knowledge Regarding Knee
OA and Joint Replacement, and a survey regarding surgery for joint replacement. At the time
of the 12-month follow-up, the patient's medical record will be accessed to check for a joint
replacement procedure.
Inclusion Criteria:
- African-American patient referred to orthopedic doctor
- Age 50 or older
- Presence of knee OA by American College of Rheumatology as evidenced by:
- Chronic, frequent knee pain based on the NHANES questions.
- Moderate to severe knee OA based on WOMAC index score 39.
- Radiographic evidence of knee OA.
Exclusion Criteria:
- Prior history of any major joint replacement.
- Terminal Illness (e.g. end stage cancer).
- Physician diagnosed inflammatory arthritis (i.e., rheumatoid arthritis, connective
tissue disease, ankylosing spondylitis, or other seronegative sypondyloarthroplasty.)
- Contra-indications to replacement surgery (e.g., lower extremity paralysis as result
of stroke).
- Prosthetic leg
- Cognitive impairment (e.g.,dementia)
- No home telephone service.
We found this trial at
1
site
Univ of Pennsylvania Penn has a long and proud tradition of intellectual rigor and pursuit...
Click here to add this to my saved trials
