Influence of Patients' Gender on Informed Decision Making Regarding Total Knee Arthroplasty
Article first published online: 26 JUL 2013
Copyright © 2013 by the American College of Rheumatology
Arthritis Care & Research
Volume 65, Issue 8, pages 1281–1290, August 2013
How to Cite
Borkhoff, C. M., Hawker, G. A., Kreder, H. J., Glazier, R. H., Mahomed, N. N. and Wright, J. G. (2013), Influence of Patients' Gender on Informed Decision Making Regarding Total Knee Arthroplasty. Arthritis Care Res, 65: 1281–1290. doi: 10.1002/acr.21970
- Issue published online: 26 JUL 2013
- Article first published online: 26 JUL 2013
- Accepted manuscript online: 11 FEB 2013 10:08AM EST
- Manuscript Accepted: 18 JAN 2013
- Manuscript Received: 7 JAN 2008
- Canadian Institutes of Health Research and the Arthritis Society of Canada
- Peterborough K. M. Hunter Graduate Studentship
- Canadian Arthritis Network Graduate Student Award
- Toronto Star Bursary Award
To investigate the effect of patient gender on patient–physician communication in the process of recommendation for total knee arthroplasty (TKA).
Seventy-one physicians (38 family physicians and 33 orthopedic surgeons) in Ontario performed blinded assessments of 2 standardized patients (1 man and 1 woman) with moderate knee osteoarthritis and otherwise identical scenarios. Four surgeons did not consent to including their data. Standardized patients and accompanying mock family members recorded elements of informed decision making (IDM) as present/absent in the patient–physician discussion and rated the physicians' interpersonal skills.
Overall, the completeness of IDM was low, but was lower still for the woman. Only 57% (38 of 67) and 15% (10 of 67) of physicians discussed the nature of the decision and elicited the patient's preference while consulting with the man and woman, respectively. Even after adjusting for physicians' recommendations regarding TKA, when interacting with the woman, physicians included fewer IDM elements (adjusted mean difference in IDM score 1.2 [95% confidence interval (95% CI) 0.6, 1.8]; P < 0.001) and had poorer interpersonal skills (adjusted mean difference 14.1 [95% CI 9.0, 19.2]; P < 0.001) compared with their consultation with the man.
Physicians provided less medical information and less encouragement to participate in the decision to undergo TKA to a woman compared with a man, irrespective of their recommendation regarding TKA. Our findings suggest that in addition to directly influencing physicians' clinical decision making, gender bias may also influence physicians' interpersonal behavior.