The Journal of Bone and Joint Surgery (American). 2008;90:1427-1435.
doi:10.2106/JBJS.G.01077
© 2008 The Journal of Bone and Joint Surgery, Inc.
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Older Patients' Unexpressed Concerns About Orthopaedic Surgery

Pamela L. Hudak, BScPT, PhD1, Kristy Armstrong, MSc2, Clarence Braddock, III, MD, MPH3, Richard M. Frankel, PhD4 and Wendy Levinson, MD, FRCPC5

1 The Keenan Research Centre in the Li Ka Shing Knowledge Institute of St. Michael's Hospital, 30 Bond Street, Toronto, ON M5B 1W8, Canada. E-mail address: hudakp{at}smh.toronto.on.ca
2 Faculty of Medicine, University of Ottawa, 451 Smyth Road, Ottawa, ON K1H 8M5, Canada
3 Department of Medicine, Stanford University School of Medicine, 251 Campus Drive, MS0B X333, 5404, Stanford, CA 94305-5404
4 Center for Implementing Evidence Based Practice, Richard L. Roudebush Veterans Administration Medical Center, Indiana University School of Medicine, 410 West 10th Street, Suite 2000, Indianapolis, IN 46202
5 Department of Medicine, University of Toronto, Suite 3-805, R. Fraser Elliott Building, 190 Elizabeth Street, Toronto, ON M5G 2C4, Canada

Investigation performed at St. Michael's Hospital, Toronto, Ontario, Canada

Disclosure: In support of their research for or preparation of this work, one or more of the authors received, in any one year, outside funding or grants in excess of $10,000 from the National Institute on Aging (RO1 AGO18781). Neither they nor a member of their immediate families received payments or other benefits or a commitment or agreement to provide such benefits from a commercial entity. No commercial entity paid or directed, or agreed to pay or direct, any benefits to any research fund, foundation, division, center, clinical practice, or other charitable or nonprofit organization with which the authors, or a member of their immediate families, are affiliated or associated.

Background: As the U.S. population ages, orthopaedic surgeons will increasingly be required to counsel older patients about major surgical procedures. Understanding patient concerns or worries about surgery could help orthopaedic surgeons to assist their patients in making these decisions. The objectives of this study were to explore the nature of patient concerns regarding orthopaedic surgery and to describe how patients raise concerns during visits with orthopaedic surgeons and how orthopaedic surgeons respond.

Methods: As part of a study involving audiotaping of 886 visits between patients and orthopaedic surgeons, fifty-nine patients sixty years of age or older who were considering surgery were recruited to participate in semistructured telephone interviews at five to seven days and one month after the visit. Patients were asked about their perceptions of the visit and how they made their decision about surgery. These interviews were analyzed to identify patients' concerns with the use of qualitative content analysis and then compared with the audiotaped visits to determine whether these concerns were actually raised during the visit and, if so, how well the orthopaedic surgeons responded. Analyses based on patient race (black or white) were also performed.

Results: One hundred and sixty-four concerns pertaining to (1) the surgery (anticipated quality of life after the surgery, the care facility, the timing of the operation, and the patient's capacity to meet the demands of the surgery) and (2) the surgeons (their competency, communication, and professional practices) were identified. Patients raised only 53% of their concerns with the orthopaedic surgeons and were selective in what they disclosed; concerns about the timing of the operation and about the care facility were frequently raised, but concerns about their capacity to meet the demands of the surgery and about the orthopaedic surgeons were not. Orthopaedic surgeons responded positively to 66% of the concerns raised by the patients. Only two concerns were raised in response to direct surgeon inquiry.

Conclusions: Patients raised only half their concerns regarding surgery with orthopaedic surgeons. Orthopaedic surgeons are encouraged to fully address how patients' capacity to meet the demands of the surgery, defined by their resources (such as social support, transportation, and finances) and obligations (to family members, employers, and religion), may impinge on their willingness to accept recommended surgery.


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Letters to the Editor:

Read all Letters to the Editor

Unexpressed concerns: time constraints, informed consent and surgeon grade
Ziad Harb, et al.
JBJS Online, 26 Aug 2008 [Full text]
Addressing the Unexpressed Needs of Older Patients: Making it Multidisciplinary
Dorothea Z. Lack
JBJS Online, 28 Jul 2008 [Full text]