title: Could preoperative preferences and expectations influence surgical decision making? Rheumatoid arthritis patients contemplating metacarpophalangeal joint arthroplasty.
abstract: BACKGROUND
  The goals of this assessment were to elicit rheumatoid arthritis patients' expectations of metacarpophalangeal joint arthroplasty and to explore how preoperative preferences might influence patients' surgical decision making.
  
  
  METHODS
  Rheumatoid arthritis patients who were appropriate metacarpophalangeal joint arthroplasty candidates were assessed by surgeons at three centers. Patients answered a questionnaire on expectations for metacarpophalangeal joint arthroplasty before deciding on whether to actually undergo the procedure.
  
  
  RESULTS
  Of 56 eligible patients, 41 percent decided to have surgery, 48 percent decided against it, and 11 percent were undecided. Among the 48 patients without previous metacarpophalangeal joint arthroplasty, improving hand appearance and hand function were most often cited by patients as "very important." The nonsurgical group was more likely to be most bothered by hand weakness (32 percent versus 0 percent, p = 0.03), whereas the surgical group was more likely to be bothered by poor function (62 percent versus 23 percent, p = 0.01). The nonsurgical patients were more likely to value their own opinion as most important in the surgical decision-making process (59 percent versus 29 percent, p = 0.04). Both groups overestimated the risk of serious complications, but the surgical group was less likely to believe postoperative rehabilitation would be difficult (odds ratio, 0.2; 95% CI, 0.1 to 0.9).
  
  
  CONCLUSIONS
  Patients who are eligible for metacarpophalangeal arthroplasty but decline surgery appear to have different baseline expectations and preferences than those who choose surgery. Patients who refuse surgery may use information differently in their decision-making process. Understanding and addressing patients' expectations and preferences preoperatively could help identify those patients who would most likely benefit from surgery.
authors.affiliation: New York, N.Y.; Derby, England; Baltimore, Md.; Boston, Mass.; and Ann Arbor, Mich. From the Department of Medicine, Hospital for Special Surgery; Pulvertaft Hand Centre; The Curtis National Hand Center; Foster Center for Outcomes Research, Hospital for Special Surgery; Division of Rheumatology and Department of Orthopedic Surgery, Brigham and Women's Hospital; and Section of Plastic Surgery, Department of Surgery, The University of Michigan Health System.
authors.forename: Lisa A
authors.initials: LA
authors.lastname: Mandl
authors.forename: Frank D
authors.initials: FD
authors.lastname: Burke
authors.forename: E F
authors.initials: EF
authors.lastname: Shaw Wilgis
authors.forename: Stephen
authors.initials: S
authors.lastname: Lyman
authors.forename: Jeffrey N
authors.initials: JN
authors.lastname: Katz
authors.forename: Kevin C
authors.initials: KC
authors.lastname: Chung
mesh_terms: D001172:Arthritis, Rheumatoid / Q000150:complications / Q000601:surgery*; D001178:Arthroplasty; D002755:Choice Behavior; D003430:Cross-Sectional Studies; D006227:Hand Deformities, Acquired / Q000209:etiology / Q000601:surgery*; D006801:Humans; D016916:Joint Deformities, Acquired / Q000209:etiology / Q000601:surgery; D008662:Metacarpophalangeal Joint / Q000601:surgery*; D010358:Patient Participation; D017060:Patient Satisfaction; D011446:Prospective Studies; D011795:Surveys and Questionnaires