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Title: Elderly Require More Prompting to Discuss Concerns Regarding Orthopaedic Surgery
URL: http://www.pslgroup.com/dg/226CA2.htm
Doctor's Guide
August 1, 2008

INDIANAPOLIS -- August 1, 2008 -- Older patients and their surgeons do not communicate effectively when exploring orthopaedic surgical treatment options, according to a study published in the July issue of the Journal of Bone and Joint Surgery.

"Unexpressed concerns are challenging because they can lead to different expectations and understanding of the problems patients are concerned about and treatment recommendations that are poorly tailoured to patient needs," said lead author Richard M. Frankel, PhD, Indiana University School of Medicine, Indianapolis, Indiana.

For the study, Dr. Frankel and colleagues audiotaped patient-surgeon consultations and later interviewed the patients regarding their concerns about surgery to find out what, if anything, they had not discussed with their surgeons.

The researchers found that the older patients had raised only about half of the concerns mentioned in the subsequent interview.

The authors noted that if concerns are unexpressed, "physicians will have little chance to correct or modify them. Unfortunately, unexpressed concerns may contribute to breakdowns in communication, which are frustrating for both physicians and patients."

The overwhelming majority (84%) of older patient concerns were related to the surgery itself. Concerns about anticipated quality of life after surgery, the postsurgery care facility, and timing of surgery were among those most frequently voiced.

A mere 16% of patient concerns were related to the surgeons themselves, including doubts about competency of the surgeon and the perceived tendency of surgeons to promote surgery as the only real treatment option.

The researchers found that surgeons responded well to patient concerns when they were raised, but patients appeared highly selective about what concerns they mentioned.

"Knowing that older adults frequently don't voice all their concerns should help surgeons create opportunities for patients who are reluctant to bring them up," said Dr. Frankel.

The researchers found that patients most often raised concerns when the surgeon was describing treatment recommendations and possible options. Surprisingly, few responses were elicited when surgeons asked, "Do you have any questions or concerns?"

The authors focused on orthopedic surgery because the aging US population will be increasingly faced with decisions about major orthopaedic procedures.


SOURCE: Indiana University

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