Analyzing Challenging Clinical Discussions in Orthopaedics

Effectiveness of Teach-back in Orthopedic Treatment Decision Discussions

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.

Study Overview

• Status: Terminated
• Conditions: Arthritis; Knee Osteoarthritis; Knee Arthropathy; Teach-Back Communication
• Intervention / Treatment: Other: Teach-Back Lesson

• Study Type: Interventional
• Enrollment (Actual): 7
• Phase: Not Applicable

Contacts and Locations

Study Locations

• United States
  • North Carolina
    • Durham, North Carolina, United States, 27710
      • Duke University Health System

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: 18 years to 80 years (Adult, Older Adult)
• Accepts Healthy Volunteers: No
• Genders Eligible for Study: All

Description

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

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Health Services Research
• Allocation: N/A
• Interventional Model: Single Group Assignment
• Masking: None (Open Label)

Number of Arms

1

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
Experimental: Teach-Back Group; 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; A teach-back lesson will be given to providers (teach-back group) who have challenging clinical discussions with patients

What is the study measuring?

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

Collaborators and Investigators

• Sponsor: Duke University
• Investigators: Principal Investigator: Richard C Mather III, MD, MBA, Duke University

Study record dates

Study Major Dates

• Study Start (Actual): April 17, 2017
• Primary Completion (Actual): November 7, 2018
• Study Completion (Actual): November 7, 2018

Study Registration Dates

• First Submitted: February 14, 2017
• First Submitted That Met QC Criteria: February 16, 2017
• First Posted (Actual): February 20, 2017

Study Record Updates

• Last Update Posted (Actual): December 17, 2019
• Last Update Submitted That Met QC Criteria: December 16, 2019
• Last Verified: June 1, 2018

More Information

Terms related to this study

• Additional Relevant MeSH Terms: Musculoskeletal Diseases; Rheumatic Diseases; Arthritis; Osteoarthritis; Osteoarthritis, Knee; Joint Diseases
• Other Study ID Numbers: Pro00079809

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: No

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No