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A Qualitative Analysis of Decision-Making for Total Knee Replacement in Patients With Osteoarthritis

Suarez-Almazor, Maria E. MD, PhD*; Richardson, Marsha MSW*; Kroll, Tony L. PhD; Sharf, Barbara F. PhD

JCR: Journal of Clinical Rheumatology: June 2010 - Volume 16 - Issue 4 - p 158-163
doi: 10.1097/RHU.0b013e3181df4de4
Original Article

Objective: Variation in the utilization of total knee arthroplasty (TKA) for patients with osteoarthritis has been well documented. Conceivably, patient preferences may play a major role in these differences; however, this has not been adequately assessed. The purpose of this study was to conduct a qualitative analysis of decision-making factors influencing preferences for TKA in patients with knee osteoarthritis.

Methods: We conducted 6 focus groups of patients with knee osteoarthritis from diverse ethnic backgrounds attending primary care clinics affiliated to the largest private outpatient institution in Houston, TX. All groups were lead by race-concordant facilitators. The group discussions were centered on factors considered to be important in the decision-making for TKA. Thematic analysis was conducted, using a grounded theory approach aided by qualitative software.

Results: Several themes emerged from the groups' discussions. Positive and negative personal experiences played a major role in decision-making. Generally, participants had good expectations about improved function and quality of life, but a number of fears were identified, the most prevalent being fear of a lengthy recovery, followed by fear of complications and of anesthesia. Additional emerging themes included trust in surgeon, financial concerns, and worries about general health.

Conclusions: The attitudes and beliefs of patients with knee osteoarthritis about TKA are largely based on personal experiences, expectations, and fears, and they are largely influenced by their close social environment. These findings emphasize the need for open doctor-patient communication around individual experiences to achieve satisfactory shared decision-making for TKA.

Discussion of attitudes of patients based on expectations and fears should help improve decision making about surgery.

From the *Section of Rheumatology, Department of General Internal Medicine, University of Texas MD Anderson Cancer Center, Houston, TX; and †Department of Communication, Texas A & M University, College Station, TX. Dr. Suarez-Almazor has a K24 career award from the National Institute for Arthritis, Musculoskeletal and Skin Disorders (NIAMS) and is the Director of the Houston Center for Education and Research on Therapeutics funded by the Agency for Health Quality and Research (CERTs; U18 HS016093).

Supported by the Agency for Healthcare Research and Quality (AHRQ) and the National Institutes of Health Office of Research on Minority Health through the EXCEED program (PO1HS10876).

Correspondence: Maria E. Suarez-Almazor, MD, PhD, 1515 Holcombe Blvd (Unit 437), Houston, TX 77030. E-mail:

© 2010 Lippincott Williams & Wilkins, Inc.