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Eliciting patient views on choosing the next available surgeon to reduce waiting times for joint replacement surgery: on the need to consider individual patient preferences and information needs.

Barbara Conner-Spady, Deborah Marshall, Eric Bohm, Michael Dunbar, Cy Frank, Gillian Hawker, Tom Noseworthy


Rationale, aims, and objectives:  The objective is to understand patient views on surgeon choice when being referred for joint replacement; do they prefer referral to the next available surgeon for a shorter waiting time or do they prefer their own choice of surgeon? What factors guide this decision and what information would patients find useful when deciding?

Methods:  Seven focus groups were held in four Canadian cities.  Participants had been either referred to or seen by an orthopaedic surgeon for hip or knee replacement surgery.  The method of analysis was qualitative thematic analysis.

Results:  There were 50 participants, 66% female, 60% knee replacements and the average age was 66 years (SD 12).  68% were on a waiting list for surgery and 32% were undecided about surgery.  Although patients varied in their views, many wanted some choice in their decision about a surgeon.  If patients were in severe pain, they were more likely to accept the idea of referral to the next available surgeon.  Other considerations were the recommendation of their family physician, surgeon reputation and confidence in the surgeon.  Although some patients wanted access to patient outcome data and satisfaction data, others were skeptical of data and the interpretation of statistics. 

Conclusion:  Patient views on referral to the next available surgeon are relevant to initiatives aimed at improving access to care, such as pooled surgeon waiting lists.  If implemented, waiting time is not the only important factor for patients.  Individual patient preferences and information needs must also be considered, given their pivotal significance in the development of person-centered approaches in clinical care.   

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