title: A qualitative analysis of decision-making for total knee replacement in patients with osteoarthritis.
abstract: OBJECTIVE
  Variation in the utilization of total knee arthroplasty (TKA) for patients with osteoarthritis has been well documented. Conceivably, patient preferences may play a major role in these differences; however, this has not been adequately assessed. The purpose of this study was to conduct a qualitative analysis of decision-making factors influencing preferences for TKA in patients with knee osteoarthritis.
  
  
  METHODS
  We conducted 6 focus groups of patients with knee osteoarthritis from diverse ethnic backgrounds attending primary care clinics affiliated to the largest private outpatient institution in Houston, TX. All groups were lead by race-concordant facilitators. The group discussions were centered on factors considered to be important in the decision-making for TKA. Thematic analysis was conducted, using a grounded theory approach aided by qualitative software.
  
  
  RESULTS
  Several themes emerged from the groups' discussions. Positive and negative personal experiences played a major role in decision-making. Generally, participants had good expectations about improved function and quality of life, but a number of fears were identified, the most prevalent being fear of a lengthy recovery, followed by fear of complications and of anesthesia. Additional emerging themes included trust in surgeon, financial concerns, and worries about general health.
  
  
  CONCLUSIONS
  The attitudes and beliefs of patients with knee osteoarthritis about TKA are largely based on personal experiences, expectations, and fears, and they are largely influenced by their close social environment. These findings emphasize the need for open doctor-patient communication around individual experiences to achieve satisfactory shared decision-making for TKA.
authors.affiliation: Section of Rheumatology, Department of General Internal Medicine, University of Texas MD Anderson Cancer Center, Houston, TX, USA. msalmazor@mdanderson.org
authors.forename: Maria E
authors.initials: ME
authors.lastname: Suarez-Almazor
authors.forename: Marsha
authors.initials: M
authors.lastname: Richardson
authors.forename: Tony L
authors.initials: TL
authors.lastname: Kroll
authors.forename: Barbara F
authors.initials: BF
authors.lastname: Sharf
mesh_terms: D000368:Aged; D019645:Arthroplasty, Replacement, Knee / Q000523:psychology*; D003657:Decision Making; D005260:Female; D017144:Focus Groups; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D008297:Male; D008875:Middle Aged; D020370:Osteoarthritis, Knee / Q000601:surgery*; D057240:Patient Preference