Zaidi, R;
Pfeil, M;
Macgregor, AJ;
Goldberg, A;
(2013)
How do Patients with End-Stage Ankle Arthritis Decide Between Two Surgical Treatments? A Qualitative Study.
BMJ Open
, 3
(7)
, Article 002782. 10.1136/bmjopen-2013-002782.
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Abstract
Objective: To examine how patients decide between ankle fusion and ankle replacement in end-stage ankle arthritis. Design: Purposive patient selection, semistructured interviews, thematic analysis. Setting: Royal National Orthopaedic Hospital, Stanmore, UK. Participants: 14 patients diagnosed with end-stage ankle osteoarthritis. Results: We interviewed 6 men and 8 women with a mean age of 58 years (range 41–83). All had opted for surgery after failure of at least 6 months of conservative management, sequentially trading-off daily activities to limit the evolving pain. To decide between two offered treatments of ankle fusion and total ankle replacement (TAR), three major sources informed the patients’ decision-making process: their surgeon, peers and the internet. The treating surgeon was viewed as the most reliable and influential source of information. Information gleaned from other patients was also important, but with questionable reliability, as was information from the internet, both of which invariably required validation by the surgeon and in some cases the general practitioner. Conclusions: Patients seek knowledge from a wealth of sources including the internet, web forums and other patients. While they leverage each of these sources to guide decision-making, the most important and influential factor in governing how patients decide on any particular surgical intervention is their surgeon. A high quality doctor–patient relationship, coupled with clear, balanced and complete information is essential to enable shared decision-making to become a standard model of care.
| Type: | Article |
|---|---|
| Title: | How do Patients with End-Stage Ankle Arthritis Decide Between Two Surgical Treatments? A Qualitative Study |
| Location: | England |
| Open access status: | An open access version is available from UCL Discovery |
| DOI: | 10.1136/bmjopen-2013-002782 |
| Publisher version: | http://dx.doi.org/10.1136/bmjopen-2013-002782 |
| Language: | English |
| Additional information: | © 2013 by the BMJ Publishing Group Ltd. All rights reserved. This is an Open Access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 3.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/3.0/ PMCID: PMC3717458 |
| Keywords: | Qualitative research |
| UCL classification: | UCL UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Medical Sciences UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Medical Sciences > Div of Surgery and Interventional Sci UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Medical Sciences > Div of Surgery and Interventional Sci > Department of Ortho and MSK Science |
| URI: | https://discovery.ucl.ac.uk/id/eprint/1405312 |
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