Dr. Suarez-Almazor is the Director of the Houston Center for Education and Research on Therapeutics, which is funded by Agency for Healthcare Research and Quality (grant U18-HS16093), and holds a K24 award from the National Institute of Arthritis and Musculoskeletal and Skin Diseases.
(Mis)understanding in patient-health care provider communication about total knee replacement
Article first published online: 30 DEC 2008
Copyright © 2008 by the American College of Rheumatology
Arthritis Care & Research
Volume 61, Issue 1, pages 100–107, 15 January 2009
How to Cite
Street, R. L., Richardson, M. N., Cox, V. and Suarez-Almazor, M. E. (2009), (Mis)understanding in patient-health care provider communication about total knee replacement. Arthritis & Rheumatism, 61: 100–107. doi: 10.1002/art.24371
- Issue published online: 30 DEC 2008
- Article first published online: 30 DEC 2008
- Manuscript Accepted: 10 SEP 2008
- Manuscript Received: 21 MAY 2008
- Excellence Centers to Eliminate Ethnic and Racial Disparities initiative of the Agency for Healthcare Research and Quality and the National Center for Minority Health and Health Disparities. Grant Number: P01-HS10876
- Houston VA Health Services Research and Development Center of Excellence. Grant Number: HFP90-020
To examine whether communication factors affect health care provider and patient agreement on the need for, risks of, and benefits of joint replacement, and also whether degree of agreement predicts patient satisfaction and intent to follow treatment recommendations.
Health care providers (n = 27) and patients (n = 74) with severe osteoarthritis (OA) were recruited from clinics in Houston, Texas. Patients completed a baseline survey prior to the consultation. After the visit, patients and providers completed measures of the severity of the patient's OA, the expected benefits of total knee replacement (TKR), and concern about surgical complications. Patients also completed satisfaction and intent to adhere measures. Provider communication and patient participation were measured by patient self-report and by observers' codings of audiorecordings of the consultations.
Provider-patient agreement was modest to poor regarding severity of the patient's OA and the expected benefits and risks of TKR. Providers and patients were more aligned on the patient's OA severity when providers used more partnership building but spent less time simply giving information. Differences between providers' and patients' concerns about surgery were greater when patients were less participatory, African American, or expressed lower trust in their doctors. Patient satisfaction and intent to adhere were predicted by provider-patient agreement on the benefits of TKR.
Patients and providers often differ in their beliefs about the need for, risks of, and benefits of TKR, and these differences can affect patient satisfaction and commitment to treatment. Facilitating active patient participation might contribute to greater physician–patient agreement on the patient's concerns about OA and surgical interventions.