Samantha Bunzli1, Penny O'Brien1, Nardia Klem2, Ian Incoll3,4, Jasvinder Singh5,6,7, Myles Davaris1, Peter Choong1,8, Michelle Dowsey1,8. 1. Department of Surgery, St Vincent's Hospital Melbourne, The University of Melbourne, Melbourne, Victoria, Australia. 2. School of Physiotherapy and Exercise Science, Curtin University, Perth, Western Australia, Australia. 3. Australian Orthopaedic Association, Sydney, New South Wales, Australia. 4. Faculty of Health and Medicine, University of Newcastle, Newcastle, New South Wales, Australia. 5. Medicine Service, VA Medical Center, Birmingham, Alabama, USA. 6. Department of Medicine at the School of Medicine, University of Alabama at Birmingham, Birmingham, Alabama, USA. 7. Department of Epidemiology, School of Public Health, University of Alabama at Birmingham, Birmingham, Alabama, USA. 8. Department of Orthopaedics, St. Vincent's Hospital, Melbourne, Victoria, Australia.
Abstract
INTRODUCTION: Fifty per cent of patients consent for total knee replacement (TKR) with unrealistic expectations about what it involves and can achieve. A framework is needed to help surgeons identify key knowledge gaps and misconceptions that can be targeted during the informed consent process. In this qualitative study, we explored knowledge gaps and misconceptions by asking patients to reflect on their expectations along the TKR journey. METHODS: Eligible adults were ≥18 years, 12-month post-TKR and had completed a validated expectations questionnaire pre-TKR as part of a joint replacement registry. To capture a variety of perspectives, people with a range of pre-TKR expectation scores were invited. In interviews, participants reflected on anticipated and actual experiences and unexpected experiences they had along the way. Transcripts were analysed through inductive thematic analysis. Recruitment ceased when thematic saturation was reached. ETHICS APPROVAL: Ethical approval for this study was granted by the St Vincent's Hospital Melbourne Ethics Committee (LRR 077/18). RESULTS: In the final sample (n = 20; 50% female; median age = 72 years; contralateral TKR = 11), all participants described instances where their anticipated and actual experiences diverged, including high expectations of improvements in pain/function (pre-surgical optimism), lacking awareness about anaesthetic procedures (perioperative misunderstandings), feeling unprepared for the length of the recovery period (post-operative misestimations) and trying to make sense of ongoing functional limitations (long-term misattributions). DISCUSSION AND CONCLUSION: These findings are captured in a preliminary framework of therapeutic misconception. Although future research is needed to test this framework prospectively in larger, more generalisable samples, surgeons can consider these key knowledge gaps and misconceptions when consenting for TKR.
INTRODUCTION: Fifty per cent of patients consent for total knee replacement (TKR) with unrealistic expectations about what it involves and can achieve. A framework is needed to help surgeons identify key knowledge gaps and misconceptions that can be targeted during the informed consent process. In this qualitative study, we explored knowledge gaps and misconceptions by asking patients to reflect on their expectations along the TKR journey. METHODS: Eligible adults were ≥18 years, 12-month post-TKR and had completed a validated expectations questionnaire pre-TKR as part of a joint replacement registry. To capture a variety of perspectives, people with a range of pre-TKR expectation scores were invited. In interviews, participants reflected on anticipated and actual experiences and unexpected experiences they had along the way. Transcripts were analysed through inductive thematic analysis. Recruitment ceased when thematic saturation was reached. ETHICS APPROVAL: Ethical approval for this study was granted by the St Vincent's Hospital Melbourne Ethics Committee (LRR 077/18). RESULTS: In the final sample (n = 20; 50% female; median age = 72 years; contralateral TKR = 11), all participants described instances where their anticipated and actual experiences diverged, including high expectations of improvements in pain/function (pre-surgical optimism), lacking awareness about anaesthetic procedures (perioperative misunderstandings), feeling unprepared for the length of the recovery period (post-operative misestimations) and trying to make sense of ongoing functional limitations (long-term misattributions). DISCUSSION AND CONCLUSION: These findings are captured in a preliminary framework of therapeutic misconception. Although future research is needed to test this framework prospectively in larger, more generalisable samples, surgeons can consider these key knowledge gaps and misconceptions when consenting for TKR.
Authors: Helen Slater; Joanne E Jordan; Peter B O'Sullivan; Robert Schütze; Roger Goucke; Jason Chua; Allyson Browne; Ben Horgan; Simone De Morgan; Andrew M Briggs Journal: Pain Date: 2022-04-06 Impact factor: 7.926
Authors: Daniel Gould; Sharmala Thuraisingam; Cade Shadbolt; Josh Knight; Jesse Young; Chris Schilling; Peter F Choong; Michelle M Dowsey Journal: BMJ Open Date: 2021-01-22 Impact factor: 2.692