Project 171590
Which Patients Are Most Likely To Benefit From Total Joint Arthroplasty and What Do They Need To Know?
Which Patients Are Most Likely To Benefit From Total Joint Arthroplasty and What Do They Need To Know?
Project Information
| Study Type: | Observational Cohort_Study |
| Therapeutic Area: | Musculoskeletal |
| Research Theme: | Health systems / services |
| Disease Area: | osteoarthritis |
| Data Type: | Canadian |
Institution & Funding
| Principal Investigator(s): | Hawker, Gillian A |
| Co-Investigator(s): | Badley, Elizabeth M; Borkhoff, Cornelia M; Croxford, Ruth; Davis, Aileen M; Dunn, Sheila F; Gignac, Monique A; Jaglal, Susan B; Kreder, Hans J; Sale, Joanna E |
| Institution: | Women's College Hospital (Toronto) |
| CIHR Institute: | Musculoskeletal Health and Arthritis |
| Program: | |
| Peer Review Committee: | Health Services Evaluation & Interventions Research - A |
| Competition Year: | 2008 |
| Term: | 3 yrs 0 mth |
Abstract Summary
Total joint replacement of the hip and knee, TJR, is effective in reducing pain and improving mobility in Canadians with hip/knee arthritis when medical treatment fails. However, studies show that many people with severe hip/knee arthritis are unwilling to consider TJR as a treatment option. A number of potential explanations for this unwillingness have been proposed, including misperceptions of the indications, risks and benefits of the surgery. However, it's unknown which of these is most important in determining unwillingness, and if differences exist depending on the patient's age, sex or education. Research also suggests that primary care physicians (PCPs) share many of the same misperceptions about TJR as their patients, resulting in failure to identify and refer appropriate and willing TJR candidates for surgical opinion. Our goal is to ensure that people who may benefit from TJR have an opportunity for an informed discussion about TJR with their PCP. To this end, we will interview 660 potential TJR candidates who have not been previously offered TJR and who indicate being unwilling or unsure about having TJR if it were offered. Participants will be asked the importance they place on factors identified to date as determinants of TJR willingness. Responses will be examined for differences by age, sex and education. We will also conduct focus groups in PCPs, chosen from among those who care for interview participants, to determine their perceptions of TJR, and factors affecting referral of their patients for surgical consultation. Finally, using data collected since 1994 on a group of Ontarians with hip/knee arthritis, we will evaluate the predictors of poor TJR outcome, based on changes in pain, mobility, and health care use. This research will inform the development of strategies aimed at influencing physicians' judgment about their patients' need for TJA and in turn the patients' willingness to consider this recommendation for treatment when offered.
Research Characteristics
This project includes the following research characteristics:
Study Justification
"To this end, we will interview 660 potential TJR candidates who have not been previously offered TJR and who indicate being unwilling or unsure about having TJR if it were offered."
Novelty Statement
"This research will inform the development of strategies aimed at influencing physicians' judgment about their patients' need for TJA and in turn the patients' willingness to consider this recommendation for treatment when offered."
Methodology Innovation
investigating determinants of TJR willingness and PCP referral practices, and predictors of poor TJR outcome