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

Abstract

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

Acknowledgments

Dr. Ibrahim is supported in part by a K24 Mid-Career Development Award from the National Institute of Arthritis and Musculoskeletal and Skin Diseases (K24AR055259). The views expressed in this paper are those of the author and do not represent those of the Department of Veterans Affairs, the National Institute of Arthritis and Musculoskeletal and Skin Diseases, or the National Institutes of Health.

Ethics Approval

This study was approved by the Committee for the Protection of Human Subjects at Dartmouth-Hitchcock Medical Center and the Veteran’s IRB of Northern New England (VINNE); study number 00028655. All enrolled participants were provided written informed consent.

Disclosure

Dr. Ibrahim's current employment is at the Department of Healthcare Policy and Research, Weill Cornell School of Medicine, New York, NY, USA. The authors report no other conflicts of interest in this work.