Analyzing Challenging Clinical Discussions in Orthopaedics

Study Overview
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Brief Summary
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The goal of this study is to analyze patient:provider communication surrounding the discussion of difficult clinical conversations such as knee replacement options. This study will also examine how using the teach-back communication technique can improve communication between patients and providers. Orthopedic residents, fellows, physician assistants, and attendings that agree to participate will be consented. Patients, who are likely to engage in a difficult clinical conversation, such as those who have a clinical indication for a Total Knee Replacement or a Partial Knee Replacement, will be recruited from participating providers clinical schedules. Patient:provider interactions will be recorded and then the providers will attend a 1 hour education lecture about how to use teach-back. After attending the lecture, additional patient:provider interactions will be recorded and analyzed via a qualitative approach. Additionally, providers will participate in a semi-structured interview to capture their perceptions of teach-back and what challenges and benefits they may derive from using it.

Official Title
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Effectiveness of Teach-back in Orthopedic Treatment Decision Discussions

Conditions
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Teach-Back Communication, Arthritis, Knee Osteoarthritis, Knee Arthropathy

Intervention / Treatment
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* Other: Teach-Back Lesson


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria (Patient Participants): Age 18 years and older Clinical indication for multiple treatment options Exclusion Criteria (Patient Participants): Non-English speaking Minors or non-consenting other individuals (spouses, friends, family members, children) in the patient room during the clinical visit Inclusion Criteria (Provider Participants) Age 18 years and older A resident, fellow, physician assistant, or attending in the Duke Department of Orthopaedic Surgery Exclusion criterion (Provider Participants): • Non-English speaking

Ages Eligible for Study
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Minimum Age: 18 Years
Maximum Age: 80 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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Accepts Healthy Volunteers

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Health Services Research
Intervention Model: Single Group Assignment
Masking: None (Open Label)


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: Teach-Back Group<br>A teach-back lesson will be provided to physician participants (Teach-Back Group), who are participating in challenging clinical discussions with patients | Other: Teach-Back Lesson<br>* A teach-back lesson will be given to providers (teach-back group) who have challenging clinical discussions with patients<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Provider's uninterrupted utterances | We will assess this outcome directly from audio-recorded conversations. A coding scheme will then be developed that captures the average length of provider utterance without asking a question or an interruption from a patient | End of discussion with patient, 20 minutes | 
| Patient/provider talking ratio | This outcome will also be assessed from audio-recorded conversations. The transcript will be coded and the coding scheme will compare how often and how long patients talk compared to provider talking. | End of discussion with patient, 20 minutes | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Providers perceptions about teach-back | This outcome will be assessed via semi-structured interviews. | End of semi-structured interview, one hour | 
| Providers belief of future use of teach-back | This outcome will be assessed via the semi-structured interview | End of semi-structured interview, one hour |