The final straw: a qualitative study to explore patient decisions to undergo total hip arthroplasty
The final straw: a qualitative study to explore patient decisions to undergo total hip arthroplasty
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DOI：
10.1007/s00402-008-0671-1
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发表时间：
2009-06-01
影响因子：
2.3
通讯作者：
Bhandari, Mohit
中科院分区：
文献类型：
--
作者：
Dosanjh, Sonia;Matta, Joel M.;Bhandari, Mohit
关注导致患者决定更换髋关节关节炎的复杂因素的研究受到限制，有利于关注手术结果的定量研究。本研究的目的有两个：(1)进一步探讨患者的经历和他们接受全髋关节置换术的决策过程，(2)检查影响患者对手术手术类型（入路，植入物）决定的因素。2005年，18名即将进行全髋关节置换术或已完成全髋关节置换术的患者参加了半结构化访谈（N = 9）或焦点小组（N = 9），讨论他们是否决定接受髋关节置换术。定性研究的扎根理论方法的准则和程序指导了对焦点小组和半结构化访谈所得数据的编码和内容分析。从访谈和焦点小组中出现的三个主要类别或核心概念被标记为(1)局限性，(2)心理困扰，(3)对髋关节置换术的看法。这三个类别共产生十个子类别。我们研究中的参与者都患有髋关节关节炎，超过了一定程度，所有人都决定做髋关节置换手术（“最后一根稻草”）。接受手术的决定是基于对其日常生活、人际关系和心理健康的基本质量影响日益严重的限制。参与者承认，他们对外科医生、手术类型和植入物的选择在很大程度上是基于他们希望选择一种技术，以尽量减少对肌肉的破坏，并导致快速恢复。在决定了手术类型后，参与者通过同事、家人和互联网来确定他们所在地区最合格的外科医生。我们的研究进一步揭示了患者“最后一根稻草”走向全髋关节置换术的复杂过程。外科医生应该了解患者的个人过程，以优化他们的手术经验和结果。未来的研究应着眼于根据患者对肌肉保留和“微创”入路的偏好来确定最佳的关节置换术入路。
Research focusing on the complex factors leading to patients decisions to replace their arthritic hip has been limited in favor of quantitative studies focusing on surgery outcomes. The purpose of this study was twofold: (1) to further explore patients experiences and their decision-making processes to undergo total hip arthroplasty and (2) to examine the factors that influenced patients decisions about the type of surgical procedure (approach, implants).In 2005, 18 patients who were either scheduled for an upcoming total hip arthroplasty or had completed total hip arthroplasty participated in semi-structured interviews (N = 9) or a focus group (N = 9) regarding their decision to undergo hip arthroplasty. The canons and procedures of the grounded theory approach to qualitative research guided the coding and content analysis of the data derived from the focus group and semi-structured interviews.Three main categories or core concepts that emerged from the interviews and focus group were labeled (1) limitations, (2) psychological distress, and (3) perceptions about hip arthroplasty. These three categories yielded a total of ten subcategories. The participants in our study had lived with a hip arthritis to a point beyond which all decided to have hip replacement surgery ("the final straw"). Decisions to undergo surgery were based upon an increasing severity of limitations affecting their basic quality of daily living, relationships and psychological well-being. Participants acknowledged that their choice of surgeon, type of procedure and implants were largely based on their desire to choose a technique that minimized disruption to their muscles and led to a quick recovery. Having decided on the type of surgery, participants used colleagues, family, and the internet to identify the most qualified surgeons in their area.Our study sheds further light on the complex process of patients "final straw" towards a total hip arthroplasty. Surgeons should be aware of patients personal processes in order to optimize their surgical experiences and outcomes. Future research should aim to resolve optimal approaches to arthroplasty in light of patients preferences for muscle-sparing and "minimally invasive" approaches.