Patient factors in decision-making for orthopaedic surgery: a prospective analysis

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Abstract

Background:

Previous research on surgical decision-making is inconsistent regarding the relative importance of patient and surgeon preferences for treatment. Few studies have related clinical indicators and patients’ inherent attitudes to subsequent physician recommendations and treatment decisions. In this study we evaluated the influence of a patient’s baseline attitudes and clinical factors on the patient’s intention for surgery, the physician’s recommendation about surgery, and ultimate surgical decision-making.

Methods:

Patients with musculoskeletal pain (N=202) were assessed for clinical indicators of surgery and attitudinal variables before their initial surgical consultation. Logistic regressions analyzed how baseline variables subsequently predicted surgeon’s recommendations and whether or not the patient had surgery, and compared the relative importance of the predictors. We also examined which variables predicted adherence to surgeon’s recommendations.

Results:

Higher baseline pain, disability, knowledge of risks, and family encouragement for surgery positively predicted the patient’s intention to have surgery, which, in turn, was the strongest predictor of the surgeon’s recommendation. Both surgeon’s recommendation and patient’s baseline intention for surgery jointly predicted final treatment decisions. In addition, patient’s intention for surgery was the only predictor of whether or not patients adhered to their surgeon’s recommendation.

Conclusions:

Patients may form strong opinions about surgery before consulting a surgeon, and these opinions impact the physician’s recommendation and ultimate treatment decisions, sometimes leading patients to act inconsistently with their surgeon’s recommendation. These findings help clarify the influence that patients have in treatment decision-making and highlight the importance of recognizing the critical role of patients’ backgrounds in elective surgery.

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