BACKGROUND/RATIONALE:
This study examines the potential roles of orthopedic surgeon and patient communication and decision-making in observed racial disparities in utilization of joint replacement- an effective treatment option for end-stage knee and hip osteoarthritis (OA). Numerous studies document the existence of racial/ethnic disparities in the utilization of knee and hip joint replacement in OA management. African-American (AA) patients are reported to be two to five times less likely than white patients to receive joint replacement for knee or hip OA.
Prior work by our VA research team found that, compared to white patients, AA patients hold different beliefs about knee/hip arthritis care, are less willing to consider joint replacement, and perceive worse outcomes from joint replacement surgery. However, it is not yet known how these racial differences in perceptions and expectations shape decision-making regarding knee or hip arthritis treatment. The role of patient-physician interactions and communication in this disparity also remains unknown.
OBJECTIVE(S):
The specific aims of this project are (1) To assess racial differences in the proportion of patients who receive recommendations for joint replacement as a treatment option, who accept treatment recommendations, who are satisfied with the treatment decision, and who undergo joint replacement surgery within 6 months of the recommendation; (2) To examine racial differences in patient-provider communication content and processes (style/pattern) regarding knee/hip OA and joint replacement as a treatment option; and (3) To examine the association between doctor-patient communication, patient race, and study outcomes.
METHODS:
This is a 3-year cross-sectional study of 435-591 patients (130-150 AA patients and 305-441 white patients) who are potential candidates for knee or hip joint replacement and who are undergoing evaluation by an orthopedic surgeon for knee or hip OA management. Using previously developed multimethod research techniques, we are examining the doctor-patient interaction in the decision-making process for knee and hip OA. Specifically, patient preferences and expectations regarding joint replacement are assessed via a structured interview. Next, patients' discussions with an orthopedic doctor are audio-taped. These discussions will be coded for content and process using the Roter Interaction Analysis System and the Informed Decision Making Model. After the clinical visit, patients are interviewed regarding their perceptions of the communication with the doctor and about their understanding of the doctor's recommendations. Patients are interviewed by phone 6 months after study enrollment regarding whether they have had joint replacement or not.
FINDINGS/RESULTS:
We have thus far enrolled 537 (139 African American and 390 White 8 other) participants in the study. We have also enrolled 59 orthopedic surgeons. Major activities completed in the last 12 months include: continued enrollment of patients and surgeons, and coding of audio data with the RIAS system, data cleaning, organizing, and coding. .
IMPACT:
The knowledge gained from this proposal will be applied to develop and test an evidence-based intervention to reduce or eliminate racial disparity in the utilization of joint replacement for knee/hip OA. This study is innovative because it is the first to examine the impact of race and patient-physician communication on orthopedic decision-making in this disparity. Findings of this study could help improve the utilization of total knee/hip arthroplasty among patients who are in need of this treatment and are not currently utilizing it. Findings will also aid in better understanding the doctor patient relationship through analysis of communication during doctor patient consults.
PUBLICATIONS:
Journal Articles
- Emejuaiwe N, Jones AC, Ibrahim SA, Kwoh CK. Disparities in joint replacement utilization: a quality of care issue. Clinical and Experimental Rheumatology. 2007; 25(6 Suppl 47): 44-9.
