Digital decision aid boosts shared decision-making in knee replacement consultations

Editor's Note

A personalized digital tool is helping patients and orthopedic surgeons make more informed, confident decisions about total knee replacement (TKR), according to BMC Health Services Research October 21. Both patients and surgeons reported the EKIT tool—a tablet-based decision aid developed in Germany—improves shared decision-making (SDM), enhances communication, and supports guideline-based care during TKR consultations.

Developed from national evidence-based practice guidelines, the EKIT tool combines patient-reported data with visualized health information and surgeon input to align treatment recommendations with individual expectations and clinical criteria. In interviews with nine patients and eight orthopedic surgeons, researchers found the tool encouraged more structured, patient-centered discussions and greater clarity about the likelihood of achieving specific outcomes through surgery.

Patients said the tool helped them better understand their knee condition and treatment options, while surgeons valued its ability to standardize consultations and validate clinical decisions. Even patients who had already decided on surgery found the tool affirming and reported greater confidence in their choices.

However, the study identified barriers that may limit widespread adoption. Surgeons cited longer consultation times and the challenge of tailoring discussions to patients’ varying health literacy levels and information needs. Some patients felt overwhelmed by the volume of data or struggled with the tablet interface due to age, visual impairments, or limited digital experience. Both groups suggested that allowing patients to complete portions of the tool at home could improve usability and efficiency.

The study concluded all identified barriers are addressable through revisions, such as simplifying graphics, adapting health information to literacy levels, and integrating flexible use options. Many orthopedic surgeons recommended expanding the EKIT model to other elective procedures, such as total hip replacement.