title: Influence of patients' gender on informed decision making regarding total knee arthroplasty.
abstract: OBJECTIVE
  To investigate the effect of patient gender on patient-physician communication in the process of recommendation for total knee arthroplasty (TKA).
  
  
  METHODS
  Seventy-one physicians (38 family physicians and 33 orthopedic surgeons) in Ontario performed blinded assessments of 2 standardized patients (1 man and 1 woman) with moderate knee osteoarthritis and otherwise identical scenarios. Four surgeons did not consent to including their data. Standardized patients and accompanying mock family members recorded elements of informed decision making (IDM) as present/absent in the patient-physician discussion and rated the physicians' interpersonal skills.
  
  
  RESULTS
  Overall, the completeness of IDM was low, but was lower still for the woman. Only 57% (38 of 67) and 15% (10 of 67) of physicians discussed the nature of the decision and elicited the patient's preference while consulting with the man and woman, respectively. Even after adjusting for physicians' recommendations regarding TKA, when interacting with the woman, physicians included fewer IDM elements (adjusted mean difference in IDM score 1.2 [95% confidence interval (95% CI) 0.6, 1.8]; P < 0.001) and had poorer interpersonal skills (adjusted mean difference 14.1 [95% CI 9.0, 19.2]; P < 0.001) compared with their consultation with the man.
  
  
  CONCLUSIONS
  Physicians provided less medical information and less encouragement to participate in the decision to undergo TKA to a woman compared with a man, irrespective of their recommendation regarding TKA. Our findings suggest that in addition to directly influencing physicians' clinical decision making, gender bias may also influence physicians' interpersonal behavior.
authors: The Hospital for Sick Children and University of Toronto, Toronto, Ontario, Canada. cory.borkhoff@sickkids.ca
authors: Cornelia M
authors: CM
authors: Borkhoff
authors: Gillian A
authors: GA
authors: Hawker
authors: Hans J
authors: HJ
authors: Kreder
authors: Richard H
authors: RH
authors: Glazier
authors: Nizar N
authors: NN
authors: Mahomed
authors: James G
authors: JG
authors: Wright
mesh_terms: D000328:Adult; D000368:Aged; D019645:Arthroplasty, Replacement, Knee / Q000523:psychology*; D003657:Decision Making; D005260:Female; D006801:Humans; D007258:Informed Consent; D007398:Interpersonal Relations; D008297:Male; D008875:Middle Aged; D010817:Physician-Patient Relations; D012737:Sex Factors; D063507:Sexism