Oral and Poster Presentation ARA-NSW 2021 - 43rd Annual NSW Branch Meeting

Development of a patient decision aid on subacromial decompression surgery and rotator cuff repair surgery (#24)

Joshua R Zadro 1 , Caitlin Jones 1 , Ian Harris 2 , Rachelle Buchbinder 3 4 , Denise O'Connor 3 4 , Kirsten McCaffery 5 , Rachel Thompson 5 , Sascha Karunaratne 6 , Christopher Maher 1 , Min Jiat Teng 1 , Tammy Hoffman 7
  1. Institute for Musculoskeletal Health, School of Public Health, The University of Sydney, Camperdown, NEW SOUTH WALES, Australia
  2. Ingham Institute for Applied Medical Research, South Western Sydney Clinical School, University of New South Wales, Sydney, NSW, Australia, Sydney , NSW, Australia
  3. Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria , Australia
  4. Monash Department of Clinical Epidemiology, Cabrini Institute, Melbourne, Victoria, Australia
  5. School of Public Health, Faculty of Medicine and Health, The University of Sydney, Camperdown, NSW, Australia
  6. Surgical Outcomes Research Centre, Royal Prince Alfred Hospital, Camperdown, NSW, Australia
  7. Institute for Evidence-Based Healthcare, Faculty of Health Sciences and Medicine, Bond University, Gold Coast, Queensland, Australia

Background: Subacromial decompression surgery and rotator cuff repair surgery are frequently performed for people with rotator cuff disease, despite evidence they provide little-to-no benefit over non-surgical options.

Objective: To develop and user test a patient decision aid that presents evidence-based information on the benefits and harms of subacromial decompression surgery and rotator cuff repair surgery, compared to non-surgical options.

Methods: We developed the decision aid guided by the International Patient Decision Aids Standards. We assembled a multidisciplinary steering group, used existing decision aids and decision science to draft the decision aid, interviewed people with shoulder pain and health professionals who manage these patients to gather feedback on the decision aid, assessed useability (using qualitative and quantitative methods), and performed iterative cycles of re-drafting the decision aid and re-interviewing participants as necessary. Interview data were analysed using thematic analysis. Quantitative data were summarised descriptively.

Results: We interviewed 26 health professionals (11 physiotherapists, 7 orthopaedic surgeons, 4 general practitioners, 3 chiropractors and 1 osteopath) and 14 people with shoulder pain. Most health professionals and people with shoulder pain rated all aspects of decision aid usability as adequate-to-excellent (e.g., length, amount of information, presentation, comprehensibility). Interviews highlighted agreement among health professionals and people with shoulder pain on most aspects of the decision aid (e.g. treatment options, summary of benefits, harms and practical issues, questions to ask a health professional, graphics, formatting). However, some aspects of the decision aid elicited divergent views among health professionals (e.g. causes and symptoms of shoulder pain, evidence on benefits and harms).

Conclusion: This decision aid could be an acceptable and valuable tool for helping people with shoulder pain make informed treatment choices. A randomised controlled trial evaluating whether this decision aid reduces people’s intentions to undergo shoulder surgery and facilitates informed treatment choices is underway.