Structure and Importance of Patients' Reasons for Treatment Choices in HIP and Knee Osteoarthritis: a Concept Mapping Study

BACKGROUND: To improve patients' allocation to non-surgical treatment options of hip and knee osteoarthritis (OA)1,2, in-depth understanding of reasons underlying patients' treatment choices is required. The current study adopted a concept mapping method3 to thematically analyse and prioritise reasons for treatment choice from a patients' perspective. OBJECTIVES: To identify and structure the reasons for treatment choices perceived by patients with hip or knee OA, and to clarify the priority of these reasons for patients when making a treatment decision. METHODS: Multiple reasons for treatment choices of hip and knee OA were identified using in-depth interviews. In consensus meetings, 51 representative reasons were derived from the interviews by researchers, medical specialists and health professionals. Subsequently, 36 patients sorted the 51 reasons in two card-sorting tasks: one based on similarity of reasons and one based on importance of reasons. The results of the first card-sorting task provided input for the hierarchical cluster analysis (squared Euclidian distances, Ward's method). In the second card-sorting task, patients ranked the importance of the reasons in 5 piles of equal size ranging from “least important” (“1”) to “most important” (“5”) when considering a treatment for OA. Mean scores and standard deviations were calculated for each cluster. RESULTS: The hierarchical structure of reasons for treatment choices in OA (Figure 1) showed a highest-order distinction between two clusters: “barriers” (subdivided into “context” and “disadvantages”) and “outcome” (subdivided into “treatment” and “personal life”). At the lowest level, 17 clusters were identified including the 51 reasons. From the lower-order clusters, the cluster “physical functioning” was assessed as most important (M=3.88, SD=1.13) and the cluster “indifference” (M=1.77, SD=1.06) as least important when making a treatment decision for hip or knee OA. CONCLUSIONS According to patients with hip and knee OA, reasons to choose a specific treatment include external and personal barriers and expectations regarding the outcome of treatment and personal life. The structured overview of reasons can be used by healthcare providers when counselling patients to support informed shared-decision making. Ultimately this may lead to optimized treatment choices. We will use these results as input for the development of a questionnaire assessing patients' individual considerations to choose specific treatment options