Older people considering major orthopedic surgery only bring up about half of their concerns when they meet with their surgeon to discuss the operation, a new study shows.The impact of conditions requiring orthopedic surgery, such as joint replacement, is "enormous and growing," Dr. Wendy Levinson of the University of Toronto and her colleagues note in The Journal of Bone & Joint Surgery. The decision to undergo elective orthopedic surgery can be particularly "difficult and confusing" for older people, they point out.
To investigate how well orthopedic surgeons and their patients communicate in such situations, the researchers listened to interviews with 59 patients, 60 years or older, 5 to 7 days after an audiotaped consultation with the physician and again 1 month after the meeting.
Patient interviews identified a total of 164 separate concerns, 84 percent of which were about the surgery, most frequently what their quality of life would be after the operation. Other concerns included the timing of the surgery and where recovery and rehabilitation would take place.
Just over half of the concerns the patients mentioned in their interviews had actually been raised in their meeting with the surgeon, the researchers found.
Most of the patients did not discuss concerns about their ability to physically handle the surgery and very few discussed concerns about their surgeons.
Just two concerns were discussed in response to the surgeon asking the patient if there were any questions or concerns. Most commonly, patients raised their concerns while they were discussing treatment recommendations and options with the surgeon.
Two thirds of the time, the surgeons responded positively to the patient's concerns. But 29 percent of their responses were "inadequate," according to the researchers, for example consisting of "minimal tokens of acknowledgment" such as saying "mmm hmm" or "yeah," or acknowledging concerns while not offering any practical advice on how to address them.
Only one of the surgeons' responses to patient concerns included "an explicit statement of empathy."
"Knowing that patients are less likely to bring up concerns about their capacity to face the demands of surgery, orthopedic surgeons could routinely provide opportunities to discuss those issues," the researchers write.
The authors also suggest that during discussions with patients, surgeons stop "competing activities," such as writing in the patient's medical record, turn and look toward the patient, and ask if there is "something else," rather than "anything else" he or she wants to talk about; this approach has been shown to be a more effective way to get patients to talk about their concerns.
"Finally, when appropriate to do so, orthopedic surgeons should reassure patients that they have a good deal of experience with the contemplated surgical procedure," the researchers conclude.
SOURCE: The Journal of Bone & Joint Surgery, July 2008.
To investigate how well orthopedic surgeons and their patients communicate in such situations, the researchers listened to interviews with 59 patients, 60 years or older, 5 to 7 days after an audiotaped consultation with the physician and again 1 month after the meeting.
Patient interviews identified a total of 164 separate concerns, 84 percent of which were about the surgery, most frequently what their quality of life would be after the operation. Other concerns included the timing of the surgery and where recovery and rehabilitation would take place.
Just over half of the concerns the patients mentioned in their interviews had actually been raised in their meeting with the surgeon, the researchers found.
Most of the patients did not discuss concerns about their ability to physically handle the surgery and very few discussed concerns about their surgeons.
Just two concerns were discussed in response to the surgeon asking the patient if there were any questions or concerns. Most commonly, patients raised their concerns while they were discussing treatment recommendations and options with the surgeon.
Two thirds of the time, the surgeons responded positively to the patient's concerns. But 29 percent of their responses were "inadequate," according to the researchers, for example consisting of "minimal tokens of acknowledgment" such as saying "mmm hmm" or "yeah," or acknowledging concerns while not offering any practical advice on how to address them.
Only one of the surgeons' responses to patient concerns included "an explicit statement of empathy."
"Knowing that patients are less likely to bring up concerns about their capacity to face the demands of surgery, orthopedic surgeons could routinely provide opportunities to discuss those issues," the researchers write.
The authors also suggest that during discussions with patients, surgeons stop "competing activities," such as writing in the patient's medical record, turn and look toward the patient, and ask if there is "something else," rather than "anything else" he or she wants to talk about; this approach has been shown to be a more effective way to get patients to talk about their concerns.
"Finally, when appropriate to do so, orthopedic surgeons should reassure patients that they have a good deal of experience with the contemplated surgical procedure," the researchers conclude.
SOURCE: The Journal of Bone & Joint Surgery, July 2008.
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