When knee pain began to take the joy out of caring for her new grandson, Lorraine Howell's doctor referred her to an orthopaedic surgeon at Group Health Cooperative, a Seattle-based, nonprofit health system. He also handed her a "decision aid" – an instructional booklet and video that clearly and objectively outlined the pros and cons of different treatment options for knee osteoarthritis, or OA.

Howell says the video didn't persuade her to choose the course she did – losing extra pounds instead of undergoing surgery to replace her arthritic knee. But it did allow her to have a more focused conversation with the surgeon. "Using the decision aid helped me feel more educated, so when [the surgeon] laid out all the options, I was able to ask informed questions," she says. "It was a real conversation, not just me nodding and saying, 'Fine, fine.'"

Her experience matches that of other Group Health patients with arthritis who received orthopaedic decision aids. A study by Group Health researchers found rates of knee and hip replacement surgeries dropped by 38 and 26 percent, respectively, over six months after the aids were introduced.

The study, published in 2012 in Health Affairs, compared joint replacement rates and costs in more than 9,500 patients with hip and knee OA. Some had their initial visit before Group Health began distributing decision aids and some after. Not only did surgery rates decline in the group receiving the videos, so did costs – by 12 to 21 percent.

"Our clinical findings are consistent with the results of randomized trials of decision aids in many settings, not just surgery,” says study leader David Arterburn, MD, an internist and associate researcher at the Group Health Research Institute in Seattle. “Those trials showed that people who use decision aids are better informed, more confident in their decision making and more satisfied with the quality of care."

They are also more likely to favor conservative treatment. Dr. Arterburn says most people with hip or knee arthritis have several therapeutic options, each with pros and cons. No single treatment is clearly right. "When patients see no winner, prior studies show they choose less invasive procedures more often," he notes.