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Duration of military service is associated with decision quality in Veterans considering total knee replacement: case series

Authors Sabatino MJ, Reilly CA, Kunkel ST, Titus AJ, Ramkumar DB, Goodney PP, Ibrahim SA, Lurie JD, Henderson ER

Received 24 January 2018

Accepted for publication 22 May 2019

Published 5 July 2019 Volume 2019:10 Pages 209—215


Checked for plagiarism Yes

Review by Single-blind

Peer reviewer comments 3

Editor who approved publication: Dr Liana Bruce (formerly Castel)

Matthew J Sabatino,1,2 Clifford A Reilly,1 Samuel T Kunkel,1,2 Alexander J Titus,2,3 Dipak B Ramkumar,1,2 Philip P Goodney,2,4 Said A Ibrahim,5,6 Jonathan D Lurie,1,2 Eric R Henderson2,7

1Department of Orthopaedic Surgery, Dartmouth-Hitchcock Medical Center, Lebanon, NH 03756, USA; 2The Geisel School of Medicine, Dartmouth College, Hanover, NH 03755, USA; 3Program in Quantitative Biomedical Sciences, Geisel School of Medicine, Hanover, NH 03755, USA; 4Vascular Surgery Section, White River Junction VAMC, White River Junction, VT 05009, USA; 5Department of Medicine, University of Pennsylvania School of Medicine, Philadelphia, PA 19104, USA; 6Center of Innovation for Health Equity Research and Promotion (CHERP), VA Health Services and Research Development, Philadelphia, PA, 19104, USA; 7Orthopaedic Section, White River Junction VAMC, White River Junction, VT 05009, USA

Purpose: Due to the nature of military service, the patient–physician relationship in Veterans is unlike that seen in civilian life. The structure of the military is hypothesized to result in barriers to open patient–physician communication and patient participation in elective care decision-making. Decision quality is a measure of concordance between a chosen treatment and the aspects of medical care that matter most to an informed patient; high decision quality is synonymous with patient-centered care. While past research has examined how age and other demographic factors affect decision quality in Veterans, duration of military service, rank at discharge, and years since discharge have not been studied.
Patients and methods: We enrolled 25 Veterans with knee osteoarthritis at a VA hospital. Enrollees completed a survey with demographic, military service, and decision-making preference questions and the Hip-Knee Decision Quality Instrument (HK-DQI), which measures patients’ knowledge about their disease process, concordance of their treatment decision, and the considered elements in their decision-making process.
Results: The HK-DQI knowledge score had a significant, positive correlation with duration of military service (R2,=0.36, p=0.004). Rank at discharge and years since discharge did not show a significant correlation with decision quality (p=0.500 and p=0.317, respectively). The concordance score did not show a statistically significant correlation with rank, duration of service, and years since discharge (p=0.640, p=0.486 and p=0.795, respectively). Additionally, decision process score was not significantly associated with rank, duration of military service, and years since discharge (p=0.380, p=0.885, and p=0.474, respectively).
Conclusion: Decision quality in Veterans considering treatment for knee osteoarthritis appears to be correlated positively with duration of military service. These findings may present an opportunity for identification of Veterans at most risk of low decision quality and customization of shared decision-making methods for Veterans by characteristics of military service.

Keywords: Veterans, decision-quality, orthopaedics, knee osteoarthritis

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