Getting Back to the Future

Marcinkowski, Kaaren; Wong, Vita Grace; Dignam, Denise

doi:10.1097/00006416-200505000-00009

Cited by 52 publications

(36 citation statements)

References 28 publications

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“…The strong desire among our participants to obtain surgery through taking charge of, and ultimately managing, their medical care is linked to their desires to regain a more active life. In fact, they actively worked at overcoming barriers to surgery, such as cost, which is consistent with Marcinkowski et al’s [50] finding that motivated osteoarthritis patients will actively work to lessen surgical wait-times. In the case of medical tourists, this ultimately involves accessing medical care in a new country with an unfamiliar health care system, which is a high level of ‘active work’ when one considers that some osteoarthritis patients will not even consider changing local surgeons to lessen wait-times [16].…”

Section: Discussionsupporting

confidence: 82%

Use of medical tourism for hip and knee surgery in osteoarthritis: a qualitative examination of distinctive attitudinal characteristics among Canadian patients

Crooks

Cameron

Chouinard

et al. 2012

BMC Health Serv Res

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BackgroundMedical tourism is the term that describes patients’ international travel with the intention of seeking medical treatment. Some medical tourists go abroad for orthopaedic surgeries, including hip and knee resurfacing and replacement. In this article we examine the findings of interviews with Canadian medical tourists who went abroad for such surgeries to determine what is distinctive about their attitudes when compared to existing qualitative research findings about patients’ decision-making in and experiences of these same procedures in their home countries.MethodsFourteen Canadian medical tourists participated in semi-structured phone interviews, all of whom had gone abroad for hip or knee surgery to treat osteoarthritis. Transcripts were coded and thematically analysed, which involved comparing emerging findings to those in the existing qualitative literature on hip and knee surgery.ResultsThree distinctive attitudinal characteristics among participants were identified when interview themes were compared to findings in the existing qualitative research on hip and knee surgery in osteoarthritis. These attitudinal characteristics were that the medical tourists we spoke with were: (1) comfortable health-related decision-makers; (2) unwavering in their views about procedure necessity and urgency; and (3) firm in their desires to maintain active lives.ConclusionsCompared to other patients reported on in the existing qualitative hip and knee surgery literature, medical tourists are less likely to question their need for surgery and are particularly active in their pursuit of surgical intervention. They are also comfortable with taking control of health-related decisions. Future research is needed to identify motivators behind patients’ pursuit of care abroad, determine if the attitudinal characteristics identified here hold true for other patient groups, and ascertain the impact of these attitudinal characteristics on surgical outcomes. Arthritis care providers can use the attitudinal characteristics identified here to better advise osteoarthritis patients who are considering seeking care abroad.

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Section: Discussionsupporting

confidence: 82%

Use of medical tourism for hip and knee surgery in osteoarthritis: a qualitative examination of distinctive attitudinal characteristics among Canadian patients

Crooks

Cameron

Chouinard

et al. 2012

BMC Health Serv Res

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“…And although patients’ preoperative expectations tended to be more optimistic in the group who was later satisfied, this difference was not significant. These results support the hypothesis that it is the fulfilment of expectations which determines satisfaction [12,13,20,22], independently of the preoperative expectation level [17]. To obtain higher satisfaction in THA, an important issue would then be to anticipate expectation fulfilment, by targeting patients with unrealistic expectations.…”

Section: Discussionsupporting

confidence: 77%

“…The first model suggests that optimistic expectations could be per se a predictor of a higher ulterior satisfaction [18,19]. According to the second model, the fulfilment of patients’ expectations, independently of their preoperative level, is the main determinant of satisfaction [12,13,20]. The third theory assumes that postoperative symptoms and function determine patients’ satisfaction, regardless of their prior expectations [11,17,21,22].…”

Section: Introductionmentioning

confidence: 99%

Determinants of satisfaction 1 year after total hip arthroplasty: the role of expectations fulfilment

Palazzo

Jourdan

Descamps³

et al. 2014

BMC Musculoskelet Disord

151

110

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BackgroundBetween 7% and 15% of patients are dissatisfied after total hip arthroplasty (THA). To assess predictors and postoperative determinants of satisfaction and expectation fulfilment one year after (THA).MethodsBefore THA surgery, 132 patients from three tertiary care centres and their surgeons were interviewed to assess their expectations using the Hospital for Special Surgery Total Hip Replacement Expectations Survey (THR survey). One year after surgery, patients (n = 123) were contacted by phone to complete a questionnaire on expectation fulfilment (THR survey), satisfaction, functional outcome (Womac), and health-related quality of life (SF 12). Univariate and multivariate analyses were performed.ResultsPreoperative predictors of satisfaction were a good mental wellbeing (adjusted OR 1.09 [1.02; 1.16], p = 0.01) and optimistic surgeons expectations (1.07 [1.01; 1.14], p = 0.02). The main postoperative determinant of satisfaction was the fulfilment of patient’s expectations (1.08 [1.04; 1.12], p < 0.001). Expectation fulfilment could be predicted before surgery by young age (regression coefficient −0.55 [−0.88; -0.21], p = 0.002), good physical function (−0.96 [−1.82; -0.10], p = 0.03) and good mental wellbeing (0.56 [0.14; 0.99], p = 0.01). Postoperative determinants of expectation fulfilment were functional outcome (−2.10 [−2.79; -1.42], p <0.001) and pain relief (−14.83 [−22.38; -7.29], p < 0.001).ConclusionTo improve patient satisfaction after THA, patients’ expectations and their fulfilment need to be carefully addressed. Patients with low mental wellbeing or physical function should be identified and specifically informed on expected surgical outcome. Surgeons’ expectations are predictive of satisfaction and information should aim to lower discrepancy between surgeons’ and patients’ expectations.

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“…For instance, surgical candidates who never intend to have surgery would be identified prior to referral, thus decreasing the wait list [13-15]. Given that patient preferences for TJA are associated with their perceptions of the risks and benefits of the procedure, discussing risks and benefits when eliciting patient preferences can also ensure that those wanting surgery can access the proper pathways [15-20]. …”

Section: Introductionmentioning

confidence: 99%

Decision aid for patients considering total knee arthroplasty with preference report for surgeons: a pilot randomized controlled trial

Stacey

Hawker

Dervin

et al. 2014

BMC Musculoskelet Disord

101

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BackgroundTo evaluate feasibility and potential effectiveness of a patient decision aid (PtDA) for patients and a preference report for surgeons to reduce wait times and improve decision quality in patients with osteoarthritis considering total knee replacement.MethodsA prospective two-arm pilot randomized controlled trial. Patients with osteoarthritis were eligible if they understood English and were referred for surgical consultation about an initial total knee arthroplasty at a Canadian orthopaedic joint assessment clinic. Patients were randomized to the PtDA intervention or usual education. The intervention was an osteoarthritis PtDA for patients and a one-page preference report summarizing patients’ clinical and decisional data for their surgeon. The main feasibility outcomes were rates of recruitment and questionnaire completion; the preliminary effectiveness outcomes were wait times and decision quality.ResultsOf 180 patients eligible for surgical consultation, 142 (79%) were recruited and randomized to the PtDA intervention (n = 71) or usual education (n = 71). Data collection yielded a 93% questionnaire completion rate with less than 1% missing items. After one year, 13% of patients remained on the surgical wait list. The median time from referral to being off the wait list (censored using survival analysis techniques) was 33.4 weeks for the PtDA group (n = 69, 95% CI: 26.0, 41.4) and 33.0 weeks for usual education (n = 71, 95% CI: 26.1, 39.9). Patients exposed to the PtDA had higher decision quality based on knowledge (71% versus 47%; p < 0.0001) and quality decision being an informed choice that is consistent with their values for option outcomes (56.4% versus 25.0%; p < 0.001).ConclusionsRecruitment of patients with osteoarthritis considering surgery and data collection were feasible. As some patients remained on the surgical waiting list after one year, follow-up should be extended to two years. Patients exposed to the PtDA achieved higher decision quality compared to those receiving usual education but there was no difference in wait for surgery.Trials registrationClinicalTrials.Gov NCT00743951

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Getting Back to the Future

Cited by 52 publications

References 28 publications

Use of medical tourism for hip and knee surgery in osteoarthritis: a qualitative examination of distinctive attitudinal characteristics among Canadian patients

Use of medical tourism for hip and knee surgery in osteoarthritis: a qualitative examination of distinctive attitudinal characteristics among Canadian patients

Determinants of satisfaction 1 year after total hip arthroplasty: the role of expectations fulfilment

Decision aid for patients considering total knee arthroplasty with preference report for surgeons: a pilot randomized controlled trial

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