To examine how patients decide between ankle fusion and ankle replacement in end-stage ankle arthritis

Goldberg, Andy

Macgregor, Alexander J

Pfeil, Michael

Zaidi, Razi

BMJ Open

English

PubMed

Razi Zaidi

Michael Pfeil

Alexander J Macgregor

Andy Goldberg

Crossref

How do patients with end-stage ankle arthritis decide between two surgical treatments? A qualitative study: Table 1

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

Spiral - Imperial College Digital Repository

How do patients with end-stage ankle arthritis decide between two surgical treatments? A qualitative study

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

Zaidi, R

Pfeil, M

Macgregor, AJ

Goldberg, A

UCL Discovery

How do Patients with End-Stage Ankle Arthritis Decide Between Two Surgical Treatments? A Qualitative Study

University of East Anglia digital repository

How do patients with end-stage ankle arthritis decide between two surgical treatments?:A qualitative study

http://dx.doi.org/10.1136/bmjopen-2013-002782

How do patients with end-stage ankle arthritis decide between two surgical treatments?:A qualitative study

Abstract

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Spiral - Imperial College Digital Repository

UCL Discovery

University of East Anglia digital repository