Aug. 2, 2008 The decision to undergo surgery can be particularly difficult and confusing for older adults. In a study published in the July 2008 issue of the Journal of Bone and Joint Surgery, Richard M. Frankel, Ph.D., of the Indiana University School of Medicine, and colleagues report that older patients and their surgeons do not communicate effectively when exploring surgical treatment options.
The researchers 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 adults had raised only about half of the concerns mentioned in the subsequent interview.
"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 tailored to patient needs," said Dr. Frankel, a professor of medicine at the IU School of Medicine and a Regenstrief research scientist. He is also is a member of the Center for Health Services Outcomes Research at the Regenstrief Institute and the Center for Implementing Evidence-Based Practice at the Richard L. Roudebush Veteran's Administration Medical Center in Indianapolis.
Dr. Frankel and his colleagues 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 percent) of older adult concerns related to the surgery itself. Concerns about anticipated quality of life after surgery, the post-surgery care facility and timing of surgery were among those most frequently voiced by older adults.
A mere 16 percent of older patient concerns were related to the surgeons 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 generally do a good job of responding to patient concerns when they are raised. However they found that patients appear highly selective about what concerns they mention.
"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 report only one statistically significant finding when comparing concerns by race. White patients were about four times more likely to express concern about their physical well-being and "going under the knife" than African-American patients.
The authors focused on orthopedic surgery because the aging U.S. population will be increasingly faced with decisions about major orthopedic procedures like joint replacement.
Co-authors of the study are Wendy Levinson, M.D. and Pamela L Hudak, Ph.D. of St. Michael's Hospital and the University of Toronto; Kristy Armstrong, M.Sc. of the University of Ottawa; and Clarence Braddock III, M.D., MPH of Stanford University.
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