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"You’re Perfect for the Procedure! Why Don’t You Want It?" Elderly Arthritis Patients’ Unwillingness to Consider Total Joint Arthroplasty Surgery: A Qualitative Study

Hospital for Sick Children and the Department of Medicine, St. Michael’s Hospital, Toronto

Jocalyn P. Clark, MSc

Department of Public Health Sciences, University of Toronto, and the Centre for Research in Women’s Health, Sunnybrook and Women’s College Health Sciences Centre, Toronto

Gillian A. Hawker, MD, MSC, FRCPC

Departments of Medicine and Health Policy, Management and Evaluation, and Clinical Epidemiology and Health Care Research Program, University of Toronto, and Sunnybrook and Women’s College Health Sciences Centre, Toronto

Peter C. Coyte, MA, PhD

Department of Health Policy, Management and Evaluation, University of Toronto

Nizar N. Mahomed, MD, ScD, FRCSC

Departments of Orthopaedic Surgery and Health Policy, Management and Administration, University of Toronto, and the Toronto Western Hospital

Hans J. Kreder, MD, MPH, FRCSC

Departments of Orthopaedic Surgery and Health Policy, Management and Administration, University of Toronto, and Sunnybrook and Women’s College Health Sciences Centre, Toronto

James G. Wright, MD, MPH, FRCSC

Departments of Surgery and Public Health Sciences and Clinical Epidemiology and Health Care Research Program, University of Toronto, and the Hospital for Sick Children, Toronto

Objective. To explore the process by which elderly persons make decisions about a surgical treatment, total joint arthroplasty (TJA). Methods. In-depth interviews with 17 elderly individuals identified as potential candidates for TJA who were unwilling to undergo the procedure. Results. For the majority of participants, decision making involved ongoing deliberation of the surgical option, often resulting in a deferral of the treatment decision. Three assumptions may constrain elderly persons from making a decision about surgery. First, some participants viewed osteoarthritis not as a disease but as a normal part of aging. Second, despite being candidates for TJA according to medical criteria, many participants believed candidacy required a level of pain and disability higher than their current level. Third, some participants believed that if they either required or would benefit from TJA, their physicians would advise surgery. Conclusion. These assumptions may limit the possibility for shared decision making. Clinical Implications. Emphasis should be directed toward thinking about ways in which discussions about TJA might be initiated (and by whom) and considering how patients’ views on and knowledge of osteoarthritis in general might be addressed.

Key Words: patient decision making • qualitative study • arthritis • total joint arthroplasty

Medical Decision Making, Vol. 22, No. 3, 272-278 (2002)
DOI: 10.1177/0272989X0202200315


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