Could preoperative preferences and expectations influence surgical decision making? Rheumatoid arthritis patients contemplating metacarpophalangeal joint arthroplasty

Lisa A. Mandl, Frank D. Burke, E. F. Shaw Wilgis, Stephen Lyman, Jeffrey N. Katz, Kevin C. Chung

Research output: Contribution to journalArticle

Abstract

BACKGROUND: The goals of this assessment were to elicit rheumatoid arthritis patients' expectations of metacarpophalangeal joint arthroplasty and to explore how preoperative preferences might influence patients' surgical decision making. METHODS: Rheumatoid arthritis patients who were appropriate metacarpophalangeal joint arthroplasty candidates were assessed by surgeons at three centers. Patients answered a questionnaire on expectations for metacarpophalangeal joint arthroplasty before deciding on whether to actually undergo the procedure. RESULTS: Of 56 eligible patients, 41 percent decided to have surgery, 48 percent decided against it, and 11 percent were undecided. Among the 48 patients without previous metacarpophalangeal joint arthroplasty, improving hand appearance and hand function were most often cited by patients as "very important." The nonsurgical group was more likely to be most bothered by hand weakness (32 percent versus 0 percent, p = 0.03), whereas the surgical group was more likely to be bothered by poor function (62 percent versus 23 percent, p = 0.01). The nonsurgical patients were more likely to value their own opinion as most important in the surgical decision-making process (59 percent versus 29 percent, p = 0.04). Both groups overestimated the risk of serious complications, but the surgical group was less likely to believe postoperative rehabilitation would be difficult (odds ratio, 0.2; 95% CI, 0.1 to 0.9). CONCLUSIONS: Patients who are eligible for metacarpophalangeal arthroplasty but decline surgery appear to have different baseline expectations and preferences than those who choose surgery. Patients who refuse surgery may use information differently in their decision-making process. Understanding and addressing patients' expectations and preferences preoperatively could help identify those patients who would most likely benefit from surgery.

Original languageEnglish (US)
Pages (from-to)175-180
Number of pages6
JournalPlastic and Reconstructive Surgery
Volume121
Issue number1
DOIs
StatePublished - Jan 2008
Externally publishedYes

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Metacarpophalangeal Joint
Arthroplasty
Rheumatoid Arthritis
Decision Making
Hand
Patient Preference
Rehabilitation
Odds Ratio

ASJC Scopus subject areas

  • Surgery

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Could preoperative preferences and expectations influence surgical decision making? Rheumatoid arthritis patients contemplating metacarpophalangeal joint arthroplasty. / Mandl, Lisa A.; Burke, Frank D.; Shaw Wilgis, E. F.; Lyman, Stephen; Katz, Jeffrey N.; Chung, Kevin C.

In: Plastic and Reconstructive Surgery, Vol. 121, No. 1, 01.2008, p. 175-180.

Research output: Contribution to journalArticle

Mandl, Lisa A. ; Burke, Frank D. ; Shaw Wilgis, E. F. ; Lyman, Stephen ; Katz, Jeffrey N. ; Chung, Kevin C. / Could preoperative preferences and expectations influence surgical decision making? Rheumatoid arthritis patients contemplating metacarpophalangeal joint arthroplasty. In: Plastic and Reconstructive Surgery. 2008 ; Vol. 121, No. 1. pp. 175-180.
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AU - Katz, Jeffrey N.

AU - Chung, Kevin C.

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N2 - BACKGROUND: The goals of this assessment were to elicit rheumatoid arthritis patients' expectations of metacarpophalangeal joint arthroplasty and to explore how preoperative preferences might influence patients' surgical decision making. METHODS: Rheumatoid arthritis patients who were appropriate metacarpophalangeal joint arthroplasty candidates were assessed by surgeons at three centers. Patients answered a questionnaire on expectations for metacarpophalangeal joint arthroplasty before deciding on whether to actually undergo the procedure. RESULTS: Of 56 eligible patients, 41 percent decided to have surgery, 48 percent decided against it, and 11 percent were undecided. Among the 48 patients without previous metacarpophalangeal joint arthroplasty, improving hand appearance and hand function were most often cited by patients as "very important." The nonsurgical group was more likely to be most bothered by hand weakness (32 percent versus 0 percent, p = 0.03), whereas the surgical group was more likely to be bothered by poor function (62 percent versus 23 percent, p = 0.01). The nonsurgical patients were more likely to value their own opinion as most important in the surgical decision-making process (59 percent versus 29 percent, p = 0.04). Both groups overestimated the risk of serious complications, but the surgical group was less likely to believe postoperative rehabilitation would be difficult (odds ratio, 0.2; 95% CI, 0.1 to 0.9). CONCLUSIONS: Patients who are eligible for metacarpophalangeal arthroplasty but decline surgery appear to have different baseline expectations and preferences than those who choose surgery. Patients who refuse surgery may use information differently in their decision-making process. Understanding and addressing patients' expectations and preferences preoperatively could help identify those patients who would most likely benefit from surgery.

AB - BACKGROUND: The goals of this assessment were to elicit rheumatoid arthritis patients' expectations of metacarpophalangeal joint arthroplasty and to explore how preoperative preferences might influence patients' surgical decision making. METHODS: Rheumatoid arthritis patients who were appropriate metacarpophalangeal joint arthroplasty candidates were assessed by surgeons at three centers. Patients answered a questionnaire on expectations for metacarpophalangeal joint arthroplasty before deciding on whether to actually undergo the procedure. RESULTS: Of 56 eligible patients, 41 percent decided to have surgery, 48 percent decided against it, and 11 percent were undecided. Among the 48 patients without previous metacarpophalangeal joint arthroplasty, improving hand appearance and hand function were most often cited by patients as "very important." The nonsurgical group was more likely to be most bothered by hand weakness (32 percent versus 0 percent, p = 0.03), whereas the surgical group was more likely to be bothered by poor function (62 percent versus 23 percent, p = 0.01). The nonsurgical patients were more likely to value their own opinion as most important in the surgical decision-making process (59 percent versus 29 percent, p = 0.04). Both groups overestimated the risk of serious complications, but the surgical group was less likely to believe postoperative rehabilitation would be difficult (odds ratio, 0.2; 95% CI, 0.1 to 0.9). CONCLUSIONS: Patients who are eligible for metacarpophalangeal arthroplasty but decline surgery appear to have different baseline expectations and preferences than those who choose surgery. Patients who refuse surgery may use information differently in their decision-making process. Understanding and addressing patients' expectations and preferences preoperatively could help identify those patients who would most likely benefit from surgery.

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