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American Association for Hand Surgery

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Development and Testing of a Decision Aid for Patients with Dupuytren's Contracture
Grace Y Kim, MD1, Melissa Roy, MD PHD2, Karen Okrainec, MD, MSc, FRCPC2, Christine B Novak, PT, PhD3, Herbert P von Schroeder, MD, MSc, FRCSC4, David R Urbach, MD, MSc, FRCSC, FACS5 and Steve McCabe, MD, MSc6, (1)University of Toronto, Toronto, ON, Canada, (2)University Health Network, Toronto, ON, Canada, (3)Toronto Western Hospital Hand Program, Toronto Rehab UHN, University of Toronto, Toronto, ON, Canada, (4)Toronto Western Hospital Hand Program, University Health Network, Toronto, ON, Canada, (5)University of Toronto and Institute of Health, Policy, Management and Evaluation, Toronto, ON, Canada, (6)Division of Plastic & Reconstructive Surgery, University of Toronto, Toronto, ON, Canada

Introduction
Dupuytren's contracture has a substantial impact on patients' quality of life. Multiple management options are available and treatment selection is a shared decision-making process based on preferences, severity of disease, impact on daily life, and other factors. There is a clear need to improve health information delivery. The literature shows high levels of decisional conflict and limited health literacy. Decision aid tools have been shown to improve patients' understanding of risks and benefits, increase patient satisfaction, and lower decisional conflict. The aim of this study was to develop and test a video decision aid for the treatment of Dupuytren's. The acceptability and effect size of video decision aid were assessed.
Methods
A video decision aid was developed presenting the four management options for Dupuytren's: observation, collagenase injection, needle aponeurotomy, and surgical release. The criteria established by the International Patient Decision Aids Standards Collaboration and the Ottawa Framework were followed. A one-year pilot study was conducted at a tertiary care academic center. Convenience sampling was used to recruit English-speaking patients with a clinical diagnosis of Dupuytren's contracture. Data collection included the Decision Aid Acceptability Questionnaire and the Decisional Conflict Scale. Descriptive statistics were performed.
Results
A total of 30 patients were included. The average age was 669 years. All participants were educated at a high-school level or higher. The distribution of the Newest Vital Sign scores indicated that 20% (n=6) patients had limited health literacy. Patient acceptability of the video revealed that the majority of patients reported that the length of the video was appropriate (93%) and that there was an adequate amount of information (87%). The information presented was rated as very useful (73%) or generally useful (27%), and all patients would recommend the decision aid to a friend. Following a standard clinical consultation with a surgeon, patients' decisional conflict scale score was 21.1517.63. In comparison, the addition of the video decision aid viewing decreased the decisional conflict scale score to 8.7512.0 (p=0.0002). The Decision Self-Efficacy Scale scores captures how confident patients are in making an informed decision and demonstrated an increase in the confidence (pre-video score of 92.810.4 and post-video score of 97.56.2; p=0.004).
Conclusions
The integration of a video decision aid to support Dupuytren's patients in making treatment decisions was well accepted by patients and lowered their decisional conflict. Ultimately, the decision aid increased patients' involvement, comprehension and empowerment in their care.


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