Evaluating the use of an Option Grid® for knee osteoarthritis for patients who are from a socially disadvantaged population. Qualitative interviews from a stepped wedge implementation trial (TOGA Study).

The problem

Concern has been expressed that decision support tools might exacerbate health inequalities as most are developed in English and may not be accessible to people with poor levels of health literacy, or who do not have English as a main language. We aimed to explore views of using an Option Grid within a consultation, focusing on how treatment options had been presented, perceptions of involvement in decision making, and the readability and utility of the Option Grid decision support tool amongst a patient population likely to be disadvantaged by age and poor health literacy.

The approach

This qualitative interview study was embedded in a trial designed to evaluate the impact of introducing Option Grids into consultations conducted by six physiotherapists in an osteoarthritis interface clinic in Oldham, Greater Manchester. We conducted interviews with 72 patients, 36 of whom had received an Option Grid within the consultation and 36 who had not. Patients also completed the REALM-R measure of health literacy. Interviews were conducted immediately following the consultation and were audio-recorded. Data were analysed thematically.

Findings

Whilst participants in both groups felt that they understood the risks and benefits of treatments, participants who had received an Option Grid appeared to have greater awareness and understanding regarding the risks and benefits of all treatment options, including sensing a structured sequence of their treatment options as their disease course progressed. All participants who had received an Option Grid expressed positive feelings about its use in the consultation, reporting that it was clear, helped them to understand their options, and made the notion of choice explicit. Most participants felt the Option Grid promoted their involvement in decision making. There were, however, occasions when participants from both groups adopted a passive stance to involvement and still felt it necessary to defer the decision to the clinician. This passivity towards involvement was particularly notable from patients who had low health literacy scores.

Consequences

Patients generally felt the Option Grid was an acceptable and useful tool that facilitated the conversation around treatment options within the consultation. However, patients with lower health literacy scores appeared to be less positive about being involved in their treatment decision and adopted a fairly passive approach to treatment decision irrespective of whether they had received an Option Grid. Continued work is necessary on how best to use short decision aids within consultations for patients who have very low health literacy.

Credits

• Fiona Wood, Pennine MSK Ltd, Oldham, Greater Manchesters, UK
• Katharine Kinsey, South East Wales Trials Unit, Cardiff University, Cardiff, Walies, UK
• Jill Firth, South East Wales Trials Unit, Cardiff University, Cardiff, Walies, UK
• Adrian Edwards, Pennine MSK Ltd, Oldham, Greater Manchesters, UK
• Katherine Brain, Pennine MSK Ltd, Oldham, Greater Manchesters, UK
• Tim Pickles, The Dartmouth Institute for Health Policy and Clinical Practice, Hanover, New Hampshire, USA
• Alan Nye, South East Wales Trials Unit, Cardiff University, Cardiff, Walies, UK
• Glyn Elwyn