title: A patient-centered perspective on surgery avoidance for hip or knee arthritis: lessons for the future.
abstract: OBJECTIVE
  Research indicates that there is a discrepancy between need and patient preference for total joint arthroplasty (TJA), an efficacious and cost-effective treatment for severe hip or knee arthritis. To understand this discrepancy, we conducted qualitative research to assess the illness perceptions and preferred accommodations and coping strategies of patients with advanced osteoarthritis who had expressed a preference to avoid TJA.
  
  
  METHODS
  In-depth interviews were conducted with a community sample of 29 men and women who were medically assessed as appropriate candidates for TJA but who had expressed a preference to avoid surgery. Inductive content analysis of text data was used to examine how patients' illness perceptions and preferred coping strategies related to surgery preference.
  
  
  RESULTS
  Participants frequently rejected the medicalization of arthritis, normalizing the experience of functional decline and defining it as age normative. Participants drew on a broad set of previous experiences with informal and formal care to make decisions about how to manage their condition. Previous negative encounters in medical and surgical care, including those from a distant past or those experienced vicariously, combined with the perception (reinforced by physicians and others) that doing nothing was a viable option deterred arthritis-related help seeking in the health care system.
  
  
  CONCLUSIONS
  Individuals with arthritis may benefit from additional counseling regarding effective medical and surgical treatments. Physicians may better meet patient needs by gauging patient preferences for a combination of self-management strategies and medical interventions.
authors.affiliation: University of Toronto, Toronto, Ontario, Canada. p.ballantyne@utoronto.ca
authors.forename: Peri J
authors.initials: PJ
authors.lastname: Ballantyne
authors.forename: Monique A M
authors.initials: MA
authors.lastname: Gignac
authors.forename: Gillian A
authors.initials: GA
authors.lastname: Hawker
mesh_terms: D000223:Adaptation, Psychological; D000368:Aged; D000369:Aged, 80 and over; D019644:Arthroplasty, Replacement, Hip / Q000706:statistics & numerical data*; D019645:Arthroplasty, Replacement, Knee / Q000706:statistics & numerical data*; D001294:Attitude to Health; D003657:Decision Making; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D015207:Osteoarthritis, Hip / Q000523:psychology* / Q000601:surgery; D020370:Osteoarthritis, Knee / Q000523:psychology* / Q000601:surgery; D017060:Patient Satisfaction; D018802:Patient-Centered Care / Q000639:trends*; D012720:Severity of Illness Index