Table 2

Decision-making regarding total knee replacement surgery

Concepts

Second-order interpretations

Third-order interpretations

Experience of pain

Different ways of describing pain

a) Patients viewed their symptoms as a natural part of aging and were reluctant to seek care or have surgery.

Comparison with others

Perceived status in comparison with others

b) Patients make a decision about surgery based on their perception of symptoms, and depending on their life environment.

Expectation of condition

Perceived cause and expectation of condition

c) Patients have the perception that " there are probably people worse off" and they should have priority for surgery.

d) Personal interpretations of social and cultural categories of aging determine judgements about being deserving for surgery.

Expectation of treatment

Perception of treatment options

e) Participants had negative perceptions of TKR, because of the risks associated with surgery.

Perception of health Professional's role

Relationship with health care professional

f) Participants "put their trust in surgery to alleviate the suffering, but find it hard to live in the uncertainty inflicted by the indeterminate waiting time".

g) Expectations of treatments are shaped by the balance between living a life on hold, and the risks associated with surgery.

Coping strategies

Different ways of coping with knee OA

h) "The taken for granted assumption that one needs to be in constant pain and virtually unable to move before seriously considering surgery".

Social context and social support

Life context and social support from friends and family

i) "Symptoms and information sources were the two main factors influencing patient decision-making".

j) The decision to have TKR is linked to the amount of pain being endured, and the way that information about TKR surgery is communicated to patients.

k) Determination, optimism, and trust sustained participants through the entire TKJA process.

l) The TKR outcome was viewed positively or negatively when viewed in relation to the participant's life context or environment.

m) "Preparing spouses for the role changes that occur following surgery could help patients and spouses establish realistic expectations of the recovery process".

n) Coping strategies and life context determine short and longer term outcomes of TKR surgery.

O'Neill et al. BMC Health Services Research 2007 7:52   doi:10.1186/1472-6963-7-52