Race and Preference for Knee Replacement: A Patient-Centered Intervention

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DESCRIPTION (provided by applicant): Abstract Osteoarthritis (OA) is the most prevalent form of arthritis and is among the most prevalent chronic conditions in the US. The prevalence of knee OA increases with age. With the aging of the US population, the burden of OA is expected to increase. The prevalence of knee OA among older African-Americans (AAs) is higher than that reported for whites. Yet numerous studies have documented the existence of marked racial/ethnic disparities in the utilization of knee replacement, an effective and highly utilized treatment option for advanced knee OA. Our research team conducted one of the first studies to examine the reasons why AA and white patients differ in utilization of joint replacement. We have published evidence demonstrating that, compared to similar white patients, AA potential candidates for joint replacement differ in their preferences for joint replacement, and that these differences are in part shaped by differences in knowledge about the risks/benefits of the treatment and consequently in expectations on surgical outcome. There are national calls to act on this information by testing interventions to reduce this disparity. The proposed trial is one of the first in the nation to directly assess the effect of a patient-centered intervention on AA patient's preferences for and access to knee replacement. The immediate goal of this randomized controlled trial is to assess the impact of a high quality, evidence-based, patient-centered educational intervention supplemented with targeted counseling (motivational interviewing) on AA patient preferences, expectations, and likelihood of achieving a referral for orthopedic evaluation. AA primary care patients who are potential candidates for joint replacement based on clinical severity of their disease who have no clear contra-indications for surgical intervention will be randomized to either intervention or attention control. We will assess the effect of the intervention on patient preference, expectations, and likelihood of receiving a referral for orthopedic evaluation within 12 months of the intervention. The long-term goal of this research is to implement effective interventions targeting AAs who are clinical candidates for joint replacement in a national effort to improve access to reduce and ultimately eliminate disparities in the utilization of this effective treatment option. Therefore, the specific aims are: (1) to examine the effect of the knee osteoarthritis decision aid supplemented by counseling on AA patient preferences and expectations regarding surgical outcome for knee joint replacement; (2) to examine the effect of the intervention on orthopedic surgery referral rates for AA patients; and (3) To examine the mechanism of action of the intervention (combined decision aid and counseling using motivational interviewing). A secondary aim of the proposed research is to examine the effect of the intervention on AA patients' rate of knee replacement. PUBLIC HEALTH RELEVANCE: Numerous studies have documented the existence of marked racial/ethnic disparities in the utilization of knee replacement, an effective and highly utilized treatment option for advanced knee osteoarthritis. This study will provide one of the first interventions in the nation designed to mitigate racial/ethnic disparity in access to joint replacement for patients who meet clinical indications for the treatment. The results of this study will not only inform the nation on strategies to reduce or eliminate one of most marked disparities in chronic disease management, but will also provide opportunities to improve quality of care for large segment of our society.