A patient‐centered perspective on surgery avoidance for hip or knee arthritis: Lessons for the future

Abstract

Objective. Research indicates that there is a discrepancy between need and patient preference for total joint arthroplasty (TJA), an efficacious and cost-effective treatment for severe hip or knee arthritis. To understand this discrepancy, we conducted qualitative research to assess the illness perceptions and preferred accommodations and coping strategies of patients with advanced osteoarthritis who had expressed a preference to avoid TJA. Methods. In-depth interviews were conducted with a community sample of 29 men and women who were medically assessed as appropriate candidates for TJA but who had expressed a preference to avoid surgery. Inductive content analysis of text data was used to examine how patients' illness perceptions and preferred coping strategies related to surgery preference. Results. Participants frequently rejected the medicalization of arthritis, normalizing the experience of functional decline and defining it as age normative. Participants drew on a broad set of previous experiences with informal and formal care to make decisions about how to manage their condition. Previous negative encounters in medical and surgical care, including those from a distant past or those experienced vicariously, combined with the perception (reinforced by physicians and others) that doing nothing was a viable option deterred arthritis-related help seeking in the health care system. Conclusion. Individuals with arthritis may benefit from additional counseling regarding effective medical and surgical treatments. Physicians may better meet patient needs by gauging patient preferences for a combination of self-management strategies and medical interventions.

Factors That Influence the Choice to Undergo Surgery for Shoulder and Elbow Conditions

“…Previous studies have identified that sex, ethnicity, socioeconomic status, and level of disability influence this process in patients considering hip or knee arthroplasties [3,4,6,7,[10][11][12][13][14][15][16]. Although, to our knowledge, there are no previous studies of patients with shoulder and elbow disorders for comparison, studies in patients undergoing hip or knee arthroplasties suggest that physicians are less than effective in assessing the impact of symptoms on function and the resultant levels of disability, with shared decisionmaking not occurring often enough [7,8,20].…”

Factors Affecting Willingness to Undergo Carpal Tunnel Release

“…This was done in an attempt to understand the decision-making process from the patient's perspective. Previous studies have identified factors that patients consider when they are deciding to undergo total joint arthroplasty, e.g., future expectation of pain relief, improved walking, restoration of quality of life 16,25 , fear of surgery 26,27 , arthritis severity, risks of surgery, the opinions of others 14,15 , past negative experience with surgery or unwanted treatment, and the advice or apathy shown by health professionals toward surgery 19 . In the present study, subjective symptoms were found to be the most important reason for undergoing surgery from the patient's perspective.…”

“…It should also be noted that patient concerns can be influenced by differences among health-care organizations, as was shown by a study in the United Kingdom, which found that financial considerations had little effect on the decision to cancel surgery 17 . Regardless of the given health-care system, we believe that, by understanding a patient's concerns, the physician can provide more patient-oriented consultation and enhance the quality of health care 17,19 . The Boston carpal tunnel and DASH scores improved in both study groups, and those who canceled or underwent surgery had similar self-reported outcome scores, whereas our expectation was that the two groups would have quite different functional status.…”

“…In view of the recent paradigm change of emphasis to the perspective of the patient during medical decision-making 12,13 , several studies have been performed on patient willingness, concerns, and avoidance of surgery to identify factors affecting the patient's decision to undergo total hip and knee arthroplasty [14][15][16][17][18][19] . To further understand the decision-making process with respect to the treatment of carpal tunnel syndrome, we attempted to identify the factors that affect the willingness of the patient to undergo or to avoid carpal tunnel release when the cause of carpal tunnel syndrome is not known.…”

Shared Decision-making in Orthopaedic Surgery

“…Consideration of surgery requires patients to acknowledge fears surrounding the procedure and any previous experiences. Physician opinion of the operation, the social impact of others, and knowledge and concerns about recovery can also impact patients' decisions regarding surgery [3,7,31,36,43]. Patients need to establish their goals and expectations, examine their preferences and how they relate to their ability to cope with their condition, their need for pain relief, quality-of-life restoration, and the goals and expectations of both the nonoperative and operative treatment strategies for this condition to make this decision [8,30,31,39].…”