S. Karunaratne1,2,3, I. Harris1,2,3,4, M. Horsley3, L. Trevena5, M. Solomon1,2
1Royal Prince Alfred Hospital, Surgical Outcomes Research Centre (SOuRCe), Sydney, Australia, 2Royal Prince Alfred Hospital, Institute of Academic Surgery, Sydney, Australia, 3Royal Prince Alfred Hospital, Department of Orthopaedic Surgery, Sydney, Australia, 4The University of Sydney, Institute for Musculoskeletal Health, Faculty of Medicine and Health, Sydney, Australia, 5The University of Sydney, School of Public Health, Faculty of Medicine and Health, Sydney, Australia
Background: Patients suffering from end-stage osteoarthritis are often encouraged to consider total knee arthroplasty (TKA). However, the most important goals to patients may not be taken into consideration by health professionals, leading to unrealistic expectations.
Purpose: The purpose of this study was to formulate a hierarchy of primary goals patients have prior to TKA and evaluate the agreement between patients and health professionals regarding this hierarchy of patient goals.
Methods: The five most important goals for 107 consecutive patients booked for TKA between June to October 2019 were identified. Most patients were high pain catastrophisers according to the Pain Catastrophising Scale (Mean ± SD: 27.6 ± 15.9) and reported participating in substantial shared decision-making with their surgeon according to the 9 Item Shared-Decision Making Questionnaire (Mean ± SD: 87.3 ± 13.6). Identified goals were grouped into themes and a hierarchy was formulated based on mean importance to the patient. This hierarchy was then randomised and provided to 94 health professionals involved in recommending surgery, with a mean ± SD of 16.9 ± 11.1 years in their profession. Included professionals were orthopaedic surgeons (n=49), physiotherapists (n=16), rheumatologists (n=16) and general practitioners (n=13). These health professionals ranked the provided goals based on their belief of what was most important to patients.
Results: Ten overarching goals were identified, with minimal disparity in rankings between patients and health professionals. The five most important goals to patients were mobility, reducing knee pain, improving activities of daily life and participating in social & hobby activities. The five most important goals to health professionals were reducing knee pain, improving quality of life, improving activities of daily life, regaining range of motion in the knee and participating in social & hobby activities. While improving mobility was the most important goal to patients, health professionals ranked this in the bottom half of the hierarchy. Health professionals also believed quality of life was highly important to patients, however patients ranked this in the bottom half of the hierarchy. While ranking of these goals was overall similar between each health professional group, orthopaedic surgeons reported the highest congruence with the patient hierarchy while rheumatologists reported the lowest congruence. Physiotherapists were found to have the highest overall disagreement with other health professionals and were the only health professionals to place activities of daily life in the bottom half of the hierarchy.
Conclusion(s): Pain and mobility are the most important goals to patients, with health professionals generally being able to recognise what goals are most important to patients. However in contrast to patients, health professionals ranked quality of life and mobility in opposite positions on the hierarchy. This incongruity should be considered by health professionals when educating their patients, communicating realistic treatment outcomes and structuring what benchmark tests or questions should be focused on at follow up.
Implications: Communication between patients and health professionals regarding realistic expectations of treatment should be encouraged prior to recommending TKA. Promoting a patient-centered conversation focusing on their goals and expectations for surgery will allow health professionals to address underlying issues that may negatively influence the outcome of their treatment.
Funding, acknowledgements: No funding to acknowledge
Keywords: Decision-making, Total knee arthroplasty, Goals of treatment
Topic: Orthopaedics
Did this work require ethics approval? Yes
Institution: Sydney Local Health District, Royal Prince Alfred Hospital
Committee: Royal Prince Alfred Hospital Zone
Ethics number: X19-0120 & 2019/ETH08675
All authors, affiliations and abstracts have been published as submitted.
