“You’re Perfect for the Procedure! Why Don’t You Want It?†Elderly Arthritis Patients’ Unwillingness to Consider Total Joint Arthroplasty Surgery: A Qualitative Study

Pamela L. Hudak, Jocalyn P. Clark, Gillian A. Hawker, Peter C. Coyte, Nizar N. Mahomed, Hans J. Kreder and James G. Wright
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Pamela L. Hudak: Hospital for Sick Children and the Department of Medicine, St. Michael’s Hospital, Toronto
Jocalyn P. Clark: Department of Public Health Sciences, University of Toronto, and the Centre for Research in Women’s Health, Sunnybrook and Women’s College Health Sciences Centre, Toronto
Gillian A. Hawker: Departments of Medicine and Health Policy, Management and Evaluation, and Clinical Epidemiology and Health Care Research Program, University of Toronto, and Sunnybrook and Women’s College Health Sciences Centre, Toronto
Peter C. Coyte: Department of Health Policy, Management and Evaluation, University of Toronto
Nizar N. Mahomed: Departments of Orthopaedic Surgery and Health Policy, Management and Administration, University of Toronto, and the Toronto Western Hospital
Hans J. Kreder: Departments of Orthopaedic Surgery and Health Policy, Management and Administration, University of Toronto, and Sunnybrook and Women’s College Health Sciences Centre, Toronto
James G. Wright: Departments of Surgery and Public Health Sciences and Clinical Epidemiology and Health Care Research Program, University of Toronto, and the Hospital for Sick Children, Toronto

Medical Decision Making, 2002, vol. 22, issue 3, 272-278

Abstract: Objective . To explore the process by which elderly persons make decisions about a surgical treatment, total joint arthroplasty (TJA). Methods . In-depth interviews with 17 elderly individuals identified as potential candidates for TJA who were unwilling to undergo the procedure. Results . For the majority of participants, decision making involved ongoing deliberation of the surgical option, often resulting in a deferral of the treatment decision. Three assumptions may constrain elderly persons from making a decision about surgery. First, some participants viewed osteoarthritis not as a disease but as a normal part of aging. Second, despite being candidates for TJA according to medical criteria, many participants believed candidacy required a level of pain and disability higher than their current level. Third, some participants believed that if they either required or would benefit from TJA, their physicians would advise surgery. Conclusion . These assumptions may limit the possibility for shared decision making. Clinical Implications . Emphasis should be directed toward thinking about ways in which discussions about TJA might be initiated (and by whom) and considering how patients’ views on and knowledge of osteoarthritis in general might be addressed.

Keywords: patient decision making; qualitative study; arthritis; total joint arthroplasty (search for similar items in EconPapers)
Date: 2002
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Persistent link: https://EconPapers.repec.org/RePEc:sae:medema:v:22:y:2002:i:3:p:272-278

DOI: 10.1177/0272989X0202200315

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