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Arthritis Rheum. 2009 Jan 15;61(1):100-7. doi: 10.1002/art.24371.

(Mis)understanding in patient-health care provider communication about total knee replacement.

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  • 1Texas A&M University, College Station, and The Houston Center for Quality of Care and Utilization Studies and Baylor College of Medicine, Houston, Texas.



To examine whether communication factors affect health care provider and patient agreement on the need for, risks of, and benefits of joint replacement, and also whether degree of agreement predicts patient satisfaction and intent to follow treatment recommendations.


Health care providers (n = 27) and patients (n = 74) with severe osteoarthritis (OA) were recruited from clinics in Houston, Texas. Patients completed a baseline survey prior to the consultation. After the visit, patients and providers completed measures of the severity of the patient's OA, the expected benefits of total knee replacement (TKR), and concern about surgical complications. Patients also completed satisfaction and intent to adhere measures. Provider communication and patient participation were measured by patient self-report and by observers' codings of audiorecordings of the consultations.


Provider-patient agreement was modest to poor regarding severity of the patient's OA and the expected benefits and risks of TKR. Providers and patients were more aligned on the patient's OA severity when providers used more partnership building but spent less time simply giving information. Differences between providers' and patients' concerns about surgery were greater when patients were less participatory, African American, or expressed lower trust in their doctors. Patient satisfaction and intent to adhere were predicted by provider-patient agreement on the benefits of TKR.


Patients and providers often differ in their beliefs about the need for, risks of, and benefits of TKR, and these differences can affect patient satisfaction and commitment to treatment. Facilitating active patient participation might contribute to greater physician-patient agreement on the patient's concerns about OA and surgical interventions.

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