In risk we trust? Making decisions about knee replacement

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.