title: Decision Support for Joint Replacement: Implications for Decisional Conflict and Willingness to Undergo Surgery.
abstract: The present study investigates age differences in the types of decision support that total joint replacement (TJR) candidates desire and receive when making the decision to pursue surgery. We consider the social structural (relationship to the patient) and experiential factors (network members' experience with TJR) that influence individuals' support preferences and the interactions of these factors with age. We also examine whether a lack of support is linked with increased decisional conflict and reduced willingness to undergo surgery.
  
  
  
  A telephone survey was conducted with 100 individuals (aged 40+) who were contemplating knee or hip replacement.
  
  
  
  TJR candidates desired and received decision support from health care providers, family members, and individuals who had previously undergone TJR. They reported higher deficits in informational and emotional support than in instrumental support. Overall, a lack of instrumental support was associated with greater decisional conflict; a lack of instrumental support and a lack of informational support were associated with reduced willingness to undergo TJR.
  
  
  
  Our findings point to the importance of involving both formal and informal network members in TJR discussions, and the need for informational guidance and practical assistance to reduce decisional conflict and uncertainty among individuals considering TJR.
authors.affiliation: Division of Geriatrics, Yale School of Medicine, New Haven, Connecticut.
authors.forename: Catherine
authors.initials: C
authors.lastname: Riffin
authors.affiliation: Department of Human Development, Cornell University, Ithaca, New York.
authors.forename: Karl
authors.initials: K
authors.lastname: Pillemer
authors.affiliation: Division of Geriatrics, Weill Cornell Medical College, New York.
authors.forename: M Cary
authors.initials: MC
authors.lastname: Reid
authors.affiliation: Internal Medicine, Cornell Internal Medical Associates, New York.
authors.forename: Judy
authors.initials: J
authors.lastname: Tung
authors.affiliation: Department of Human Development, Cornell University, Ithaca, New York.
authors.forename: Corinna E
authors.initials: CE
authors.lastname: L Ckenhoff
mesh_terms: D000368:Aged; D019643:Arthroplasty, Replacement / Q000523:psychology*; D003220:Conflict, Psychological; D003657:Decision Making; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010342:Patient Acceptance of Health Care / Q000523:psychology*; D012944:Social Support; D011795:Surveys and Questionnaires