Unstated factors in orthopaedic decision-making: a qualitative study

Area of Science:

• Orthopaedic Surgery
• Health Services Research
• Patient Decision-Making

Background:

• Total joint replacement (TJR) for osteoarthritis is a common elective surgery with noted inequities in provision.
• Decision-making processes for TJR may contribute to disparities in surgical access.
• Shared decision-making is advocated but its implementation in orthopaedic practice is unclear.

Purpose of the Study:

• To examine how decisions about TJR are made in orthopaedic consultations.
• To understand the dynamics of patient-clinician interactions in TJR decision-making.
• To identify factors influencing shared decision-making in TJR.

Main Methods:

• Qualitative research design using semi-structured interviews and observations.
• Recruitment of 6 clinicians and 26 patients across three hospital sites.
• Thematic analysis of observed consultations and subsequent interviews.

Main Results:

• Clinical and lifestyle factors, patient-assigned clinician roles, and communication styles were central to decision-making.
• Patients viewed clinicians as experts and deferred to their knowledge.
• While decisions were usually made in consultations, some patients expressed surprise at outcomes.

Conclusions:

• The interplay of roles and communication in TJR decision-making impacts the potential for shared decisions.
• These dynamics may contribute to variations in TJR provision.
• Explicitly addressing these factors and patient "surprise" can empower patients and improve communication.