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Individualized Stem-positioning in Calcar-guided Short-stem Total Hip Arthroplasty
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In risk we trust? Making decisions about knee replacement.

Giles Birchley1, Wendy Bertram2, Andrew J Moore1

  • 1Bristol Medical School, University of Bristol, UK.

Social Science & Medicine (1982)
|July 19, 2024
PubMed
Summary
This summary is machine-generated.

Effective risk communication in total knee replacement decisions is challenging. Patients and surgeons prioritize trust over detailed risk discussions, potentially leading to decisions influenced by disease rather than informed choice.

Keywords:
CommunicationKnee replacementQualitativeRiskShared decision-makingUnited Kingdom

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Area of Science:

  • Medical Ethics
  • Health Communication
  • Orthopedic Surgery

Background:

  • Shared decision-making in total knee replacement (TKR) necessitates clear risk communication.
  • A minority of TKR cases have severe unintended outcomes, complicating risk disclosure.
  • Current policies emphasize patient responsibility and choice in medical decisions.

Purpose of the Study:

  • To analyze how surgeons and patients communicate risks during TKR decision-making.
  • To explore the interplay between risk communication, trust, and patient autonomy.
  • To identify discrepancies between policy norms and clinical practice in risk disclosure.

Main Methods:

  • Audio-recording and analysis of 62 surgeon-patient consultations for TKR.
  • Observation of various risk communication strategies: listing, conversational, avoidance, decision-tools.
  • Qualitative assessment of communication patterns and patient/surgeon priorities.

Main Results:

  • Risk discussions were often brief, curtailed, or deferred by both parties.
  • Patients and surgeons prioritized building trusting relationships over detailed risk disclosure.
  • Clinical realities (pain, immobility) conflicted with policy norms of choice and responsibility.
  • Decisions sometimes appeared disease-coerced rather than self-determined.

Conclusions:

  • Observed communication practices may resist policy framing of patient-clinician interactions as mere transactions.
  • Trust and care play a crucial role in decision-making, requiring a nuanced policy approach.
  • Risk communication's role in building trust needs further emphasis, acknowledging its practical tensions.