title: "Keep on truckin'" or "It's got you in this little vacuum": race-based perceptions in decision-making for total knee arthroplasty.
abstract: OBJECTIVE
  Ethnic variation in the utilization of total knee arthroplasty (TKA) has been well documented, with African Americans showing significantly lower utilization rates. These differences are not explained by the prevalence or severity of knee osteoarthritis (OA). Patient preferences may contribute to differences in utilization since TKA is an elective surgery. We conducted a qualitative analysis of decision-making factors influencing ethnic preferences for TKA in patients with knee OA.
  
  
  METHODS
  Six focus group discussions were conducted with participants being divided according to race: 2 African American groups, 2 Hispanic groups, and 2 Caucasian groups. Participants were all patients with knee OA attending the same treatment facility. A total of 37 patients participated, 14 male and 23 female. Group discussions were led by a race-concordant facilitator. A grounded theory approach was used to analyze verbatim transcripts of the discussions.
  
  
  RESULTS
  Thirty distinct categories of information emerged in the analysis of the data. Four of these categories showed variation among ethnic groups and included explanations of illness, changes in lifestyle, trust and skepticism, and paying for surgery.
  
  
  CONCLUSIONS
  Patient attitudes and beliefs about TKA vary among ethnic groups. Differences in explanations of illness, changes in lifestyle, trust and skepticism, and paying for surgery are topics for discussion in the medical encounter. There is a need for open doctor-patient communication around individual experiences and beliefs in an effort to enhance decision-making for TKA.
authors.affiliation: Meadows School of Arts, Southern Methodist University, Dallas, Texas 75275-0113, USA. tkroll@smu.edu
authors.forename: Tony L
authors.initials: TL
authors.lastname: Kroll
authors.forename: Marsha
authors.initials: M
authors.lastname: Richardson
authors.forename: Barbara F
authors.initials: BF
authors.lastname: Sharf
authors.forename: Maria E
authors.initials: ME
authors.lastname: Suarez-Almazor
mesh_terms: D001741:Black or African American / Q000706:statistics & numerical data; D000368:Aged; D000369:Aged, 80 and over; D019645:Arthroplasty, Replacement, Knee / Q000706:statistics & numerical data*; D001294:Attitude to Health / Q000208:ethnology*; D003657:Decision Making; D005006:Ethnicity; D005260:Female; D017144:Focus Groups / Q000379:methods; D006630:Hispanic or Latino / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D008875:Middle Aged; D020370:Osteoarthritis, Knee / Q000208:ethnology / Q000601:surgery*; D010342:Patient Acceptance of Health Care / Q000208:ethnology*; D013781:Texas / Q000208:ethnology; D044465:White People / Q000706:statistics & numerical data