A patient-centered perspective on surgery avoidance for hip or knee arthritis: Lessons for the future

Authors

  • Peri J. Ballantyne,

    Corresponding author
    1. University of Toronto, Toronto, Ontario, Canada
    • Faculty of Pharmacy, University of Toronto, 19 Russell Street, Toronto, Ontario, Canada M5S 2S2
    Search for more papers by this author
  • Monique A. M. Gignac,

    1. Arthritis Community Research and Evaluation Unit, University Health Network, Toronto, Ontario, Canada
    2. University of Toronto, Toronto, Ontario, Canada
    Search for more papers by this author
  • Gillian A. Hawker

    1. Women's College Hospital at the University of Toronto, Toronto, Ontario, Canada
    2. Arthritis Community Research and Evaluation Unit, Toronto, Ontario, Canada
    3. University Health Network Research Institute, Toronto, Ontario, Canada
    4. Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada
    Search for more papers by this author

Abstract

Objective

Research indicates that there is a discrepancy between need and patient preference for total joint arthroplasty (TJA), an efficacious and cost-effective treatment for severe hip or knee arthritis. To understand this discrepancy, we conducted qualitative research to assess the illness perceptions and preferred accommodations and coping strategies of patients with advanced osteoarthritis who had expressed a preference to avoid TJA.

Methods

In-depth interviews were conducted with a community sample of 29 men and women who were medically assessed as appropriate candidates for TJA but who had expressed a preference to avoid surgery. Inductive content analysis of text data was used to examine how patients' illness perceptions and preferred coping strategies related to surgery preference.

Results

Participants frequently rejected the medicalization of arthritis, normalizing the experience of functional decline and defining it as age normative. Participants drew on a broad set of previous experiences with informal and formal care to make decisions about how to manage their condition. Previous negative encounters in medical and surgical care, including those from a distant past or those experienced vicariously, combined with the perception (reinforced by physicians and others) that doing nothing was a viable option deterred arthritis-related help seeking in the health care system.

Conclusion

Individuals with arthritis may benefit from additional counseling regarding effective medical and surgical treatments. Physicians may better meet patient needs by gauging patient preferences for a combination of self-management strategies and medical interventions.

Ancillary