The hip journey: An exploration of needs, treatment decision-making and psychosocial predictors of surgical outcomes in patients with hip osteoarthritis

Abstract

Hip osteoarthritis (OA) may significantly reduce patient’s quality of life because of loss of physical function and of ability to engage in valued activities. A combination of qualitative and quantitative methods was used to investigate hip OA patients’ needs across a chronic disease trajectory, emphasized on information and emotional needs, role of social support and self-efficacy and involvement in treatment decision-making. A parallel process involved developing a web-based patient decision aid (PDA) published at www.helsenorge.no/samvalg. A six phased model called The hip osteoarthritis continuum shows how patients’ information and emotional needs emerge and develops in line with the symptomatic progression of the disease, the clinical encounters and the decision-making processes. Patients clearly expressed a need for more and timely right information as well as continuous support and guidance to determine effective treatment and integrate specific self-management strategies in daily life. We further found that higher levels of reliable alliance, and general self-efficacy predicted better short-term recovery following total hip replacement in a cohort of 223 patients, controlling for age, comorbidities and preoperative health status. Patients’ intention to become engaged in decision-making during orthopedic outpatient consultations was framed by two overlapping decision-making processes, one concerning diagnostic procedures and the other about treatment decisions. The salient focus on diagnostic decisions intended to determine indication for surgery hindered balanced discussions about benefits and harms associated with all available treatment options, and how the expected outcomes of a specific choice may be affected by individuals’ motivation, expectations, preferences and life-values.