About

TKA Decision Aid is an electronic decision support tool for patients considering Total Knee Arthroplasty that is available on desktop and mobile devices.[1] It was developed in Canada to facilitate patients and their surgeons considering whether to have surgery or delay until a later time following standard guidelines for decision support tools.[2] TKA Decision Aid is based on a decision science approach that makes it easier for people to make difficult  decisions.[3]  

TKA Decision Aid provides clear, accurate and unbiased information about each option and about the risks, benefits, and concerns people may have. Since the outcomes of TKA can vary based on patient characteristics such as baseline pain, TKA individualizes information to help better set expectations about surgery. It does this by linking to routine PROMs (Patient Reported Outcome Measures) that patients are often asked to complete prior to their surgical consultation. It helps patients develop informed values, and preferences, along with the ability to share concerns, and suggests next steps that are consistent with the user's input. A 1 page pdf is created which summarizes the patients knowledge and preferences to inform the surgical consultation discussion.  

Evidence for the value of TKA Decision Aid is being collected in a Randomised Controlled Trial. [4,5] This study compared TKA Decision Aid to standard clinical practice in a high volume surgical clinic in Edmonton Canada. TKA Decision Aid is continually being evaluated and improved on the basis of its measured performance in a variety of clinical settings. 

 Using and Adapting TKA Decision Aid

Our goal is to make TKA Decision Aid available to be used without cost. There are 2 components to TKA Decision Aid that need consideration - (1) the Decision Aid content and (2) the data that provides individualized scores. 

The Decision Aid Content

The content of the TKA Decision Aid tool is copyrighted to maintain the integrity of the version that was validated in clinical studies. TKA Decision Aid content is available for use under a Creative Commons BY-NC-ND license, which means that it must be used as an exact replica, it cannot be changed or used for monetary gain, and it must be attributed to the original developers. The core TKA Decision Aid includes the SURE scale, which has been copyrighted by others but is also available for free use, subject to certain conditions. 

If you would like to use TKA Decision Aid under this license you must cite the study [4] and acknowledge  "The development of the original decision aid was supported by an unrestricted grant from the EuroQol Research Foundation as well as funding support from the Arthur JE Child Chair in Rheumatology Outcomes Research. The following organizations were involved with the development of the decision aid and implementation of the RCT study: University of British Columbia (Centre for Health Evaluation and Outcomes Sciences), University of Calgary, Alberta Bone and Joint Health Institute, University of Alberta, University of Toronto, University of Ottawa, Ottawa Hospital Research Institute, Edmonton Bone and Joint Centre and Alberta Hip and Knee Clinic." The options for using this license are:

• Use the version built on the open source decideapp.org platform hosted on servers at St. Paul's Hospital in Vancouver, BC. This system has been successfully integrated with REDCap through an Application Programming Interface (API) so that no identifiable patient information is stored on our servers. 

• Host your own version of TKA Decision Aid on the open source decideapp.org platform.

• Create a replica copy of DECIDE on your own platform (see below for procedures).

The Data that informs the Decision Aid

The data that populates the individualized estimates can vary and ideally should be based on local contexts. We currently have versions based on data collected in Alberta (WOMAC, EQ-5D 5L) and publicly available data from the UK (Oxford Knee, EQ-5D 5L). If you are using PROMs then it is important you have appropriate licenses for the PROMs instruments (e.g. information on licensing for EQ-5D, Oxford Knee, WOMAC)

Adaptations

We recognize that some adaptations might be required, either for different contexts (e.g. different PROMs, different PROMs data, or languages, new evidence) or for it to be integrated into other platforms. We are open to extend the license in these cases but ask that you:

• Engage with us early to understand the process.

• Call your version "TKA Decision Aid X.x" with proper attribution. To have confidence that your version will produce the same results that were seen in our studies, our team must review your version for 'similarity' of content and functionality and approve its use. If, in the opinion of our team, it is not sufficiently similar, you cannot call your version "TKA Decision Aid" or use any TKA Decision Aid content in it.

• Apply the same creative commons license to your version of TKA Decision Aid so that any further derivations or use will require the same conditions and similarity review by the original creators.

• Post a link to your version to this website for others to use and adapt.

Continuous Improvement

Finally, we are continuously improving TKA Decision Aid and ask that you periodically share de-identified, grouped data on key outcomes of your use with us so that we can learn from your experience. At a minimum, we ask that you share the number of uses (starts and completions), the distribution of total scores and percentage of correct answers on each knowledge question, the percentage of each response and distribution of total scores on the  SURE scale, and the percentage of individuals who choose to have surgery after completing TKA Decision Aid. 

References

1. Bansback N, Trenaman L, MacDonald KV, Hawker G, Johnson JA, Stacey D, Marshall DA. An individualized patient-reported outcome measure (PROM) based patient decision aid and surgeon report for patients considering total knee arthroplasty: protocol for a pragmatic randomized controlled trial. BMC musculoskeletal disorders. 2019 Dec;20(1):1-0. 

2. Joseph-Williams N, Newcombe R, Politi M, Durand MA, Sivell S, Stacey D, O'Connor A, Volk RJ, Edwards A, Bennett C, Pignone M, Thomson R, Elwyn G. Toward Minimum Standards for Certifying Patient Decision Aids: A Modified Delphi Consensus Process.  Medical Decision Making. 2014 34(6):699-710 

3. Bansback N, Li LC, Lynd L, Bryan S. Development and preliminary user testing of the DCIDA (Dynamic computer interactive decision application) for ‘nudging’ patients towards high quality decisions. BMC medical informatics and decision making. 2014 Dec;14(1):62. 

4. Bansback N, Trenaman L, MacDonald KV, Durand D, Hawker G, Johnson JA, Smith C, Stacey D, Marshall DA. An online individualized patient decision aid improves the quality of decisions in patients considering total knee arthroplasty in routine care: A randomized controlled trial. Osteoarthritis and Cartilage Open, Sept 2022;4(3):1-7.

5. Marshall DA, Trenaman L, MacDonald KV, Johnson JA, Stacey D, Hawker G, Smith C, Durand D, Bansback N. Impact of an online, individualized, patient reported outcome measures based patient decision aid on patient expectations, decisional regret, satisfaction, and health-related quality-of-life for patients considering total knee arthroplasty: results from a randomized controlled trial. J Eval Clin Pract 2022; 1-12 https://doi.org/10.1111/jep.13804