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"Keep on Truckin'" or "It's Got You in This Little Vacuum": Race-Based Perceptions in Decision-Making for Total Knee Arthroplasty
TONY L. KROLL, MARSHA RICHARDSON, BARBARA F. SHARF, and MARIA E. SUAREZ-ALMAZOR ABSTRACT. Objective. Ethnic variation in the utilization of total knee arthroplasty (TKA) has been well documented, with African Americans showing significantly lower utilization rates. These differences are not explained by the prevalence or severity of knee osteoarthritis (OA). Patient preferences may contribute to differences in utilization since TKA is an elective surgery. We conducted a qualitative analysis of decision-making factors influencing ethnic preferences for TKA in patients with knee OA. Methods. Six focus group discussions were conducted with participants being divided according to race: 2 African American groups, 2 Hispanic groups, and 2 Caucasian groups. Participants were all patients with knee OA attending the same treatment facility. A total of 37 patients participated, 14 male and 23 female. Group discussions were led by a race-concordant facilitator. A grounded theory approach was used to analyze verbatim transcripts of the discussions. Results. Thirty distinct categories of information emerged in the analysis of the data. Four of these categories showed variation among ethnic groups and included explanations of illness, changes in lifestyle, trust and skepticism, and paying for surgery. Conclusion. Patient attitudes and beliefs about TKA vary among ethnic groups. Differences in explanations of illness, changes in lifestyle, trust and skepticism, and paying for surgery are topics for discussion in the medical encounter. There is a need for open doctor-patient communication around individual experiences and beliefs in an effort to enhance decision-making for TKA. (First Release April 1 2007; J Rheumatol 2007;34:1069-75) Key Indexing Terms:
TOTAL KNEE ARTHROPLASTY From the Meadows School of the Arts, Southern Methodist University, Dallas; Department of General Internal Medicine, University of Texas MD Anderson Cancer Center, Houston; and the Department of Communication, Texas A & M University, College Station, Texas, USA. Supported by grant PO1 HS10876 from the Agency for Healthcare Research (Excellence Centers to Eliminate Ethnic/Racial Disparities — EXCEED), and in part by the Michael E. DeBakey Veterans Affairs Hospital, Department of Veterans Affairs. T.L. Kroll, MS, Meadows School of the Arts, Southern Methodist University; M. Richardson, MSW; M.E. Suarez-Almazor, MD, PhD, Department of General Internal Medicine, University of Texas MD Anderson Cancer Center; B.F. Sharf, PhD, Department of Communication, Texas A & M University. Address reprint requests to T.L. Kroll, Southern Methodist University, PO Box 750113, Dallas, TX 75275-0113. E-mail: tkroll@smu.edu. Accepted for publication January 15, 2007.
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