Development of a patient decision aid in relation to imaging for rotator cuff tendinopathy: a mixed-methods study

Background:
Unnecessary imaging for rotator cuff related shoulder pain is common and may be related to inadequate shared decision making.

Objective:
To develop and evaluate a patient decision aid (PDA) for people with rotator cuff-related shoulder pain to inform decision-making.

Design:
Mixed-methods study guided by the International Patient Decision Aids Standards.

Methods:
A multidisciplinary steering group guided this research. The PDA was developed iteratively, incorporating feedback from people with shoulder pain and health professionals through semi-structured interviews and acceptability questionnaires (1 = strongly disagree and 5 = strongly agree). Thematic analysis of qualitative data and descriptive analysis of quantitative data was undertaken.

Results:
Twenty health professionals and nineteen patients participated in interviews, while a separate cohort of 54 patients and 15 health professionals completed acceptability questionnaires. Most patients (74–98 %) rated the PDA as acceptable, though 37 % perceived it as biased against imaging. Health professionals (median agreement score 4/5) found the PDA useful but highlighted concerns about feasibility in time-constrained settings. Interview feedback emphasized clarity, contextualization of imaging findings, and alignment with clinical guidelines. When using the final version of the PDA in a clinical encounter, all five patients (100 %) reported that the information in the decision aid influenced their decision to have a scan, and four of the five health professionals (80 %) reported that they would use the decision aid in their practice.

Conclusion:
This decision aid appears to be an acceptable and useful tool for helping people with rotator cuff-related shoulder pain to make informed decisions about imaging. A randomized controlled trial evaluating whether this decision aid reduces people's intentions to have imaging and facilitate informed treatment choices is now needed.