Older patients' unexpressed concerns about orthopaedic surgery

Area of Science:

• Geriatric Medicine
• Orthopaedic Surgery
• Patient-Physician Communication

Background:

• Aging U.S. population necessitates increased counseling for older patients considering major surgery.
• Understanding patient concerns is crucial for effective shared decision-making in orthopaedic surgery.
• Previous research has not fully explored the nature and communication of patient concerns in this demographic.

Purpose of the Study:

• To explore the nature of patient concerns regarding orthopaedic surgery.
• To describe how patients raise concerns during consultations.
• To evaluate orthopaedic surgeons' responses to patient concerns.

Main Methods:

• Qualitative content analysis of semistructured telephone interviews with 59 older patients post-orthopaedic surgery consultation.
• Comparison of interview data with audiotaped surgical visits to identify raised concerns and surgeon responses.
• Analysis of patient concerns and communication patterns based on race.

Main Results:

• 164 patient concerns identified, categorized into surgery-related (quality of life, facility, timing, capacity) and surgeon-related (competency, communication, practices).
• Patients disclosed only 53% of their concerns, frequently raising timing and facility issues, but rarely capacity or surgeon-related concerns.
• Orthopaedic surgeons responded positively to 66% of raised concerns, with few concerns elicited by direct inquiry.

Conclusions:

• Patients communicate only about half of their concerns regarding orthopaedic surgery.
• Orthopaedic surgeons should proactively address patient capacity, including resources and obligations, to support informed surgical decisions.
• Improving communication strategies can enhance patient understanding and willingness to accept recommended orthopaedic procedures.