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Arthritis symptoms, information sources, and a constantly shifting threshold of risk-benefit ratios influenced elderly patients’ decisions about total joint replacement

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Q What are the decision making processes of elderly patients with severe arthritis who are unwilling to consider total joint replacement (TJR) surgery?




Toronto, Ontario, Canada.


17 patients (age range 59–81 y, 53% women) who had severe arthritis (confirmed by Western Ontario and McMaster Universities Osteoarthritis Index scores ⩾39 out of 100 points and x rays), and were unwilling to consider surgery.


Patients were interviewed for a mean 2.5 hours using a semistructured interview guide to elicit the sources and nature of information they received about TJR and potential sources of support; and the preferences, motivation, and needs that were important when considering the general management of arthritis and TJR. Transcribed interview data were analysed using qualitative content analysis.


3 themes described patients’ decision making processes. (1) Factors influencing decisions. Patients differed in terms of the relative importance they placed on …

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  • For correspondence: Dr J P Clark, BMJ Publishing Group, BMA House, London, UK.

  • Sources of funding: Medical Research Council of Canada and Canadian Arthritis Society.