Communication gap exists between seniors and surgeons

The decision to undergo orthopedic surgery can be particularly difficult and confusing for older adults.

In a study published in the July issue of the Journal of Bone and Joint Surgery, Richard M. Frankel, PhD, and colleagues reported that older patients and their surgeons do not communicate effectively when exploring surgical treatment options.

The researchers audiotaped patient/surgeon consultations and later interviewed the patients regarding their concerns about surgery to find out what, if anything, they had not discussed with their surgeons. The investigators discovered that the older adults had raised only about half of the concerns mentioned in the subsequent interview.

"Unexpressed concerns are challenging because they can lead to different expectations and understandings of the problems patients are concerned about, as well as treatment recommendations that are poorly tailored to patient needs," said Frankel, a professor of medicine at the Indiana University School of Medicine and a Regenstrief research scientist, in a press release.

Frankel and his colleagues noted that if concerns are unexpressed, "Physicians will have little chance to correct or modify them. Unfortunately, unexpressed concerns may contribute to breakdowns in communication, which are frustrating for both physicians and patients."

The overwhelming majority (84%) of older adult concerns related to the surgery itself, according to the press release. Concerns about anticipated quality of life after surgery, the postsurgery care facility and the timing of surgery were among those most frequently voiced by the older adults.

A mere 16% of older patient concerns were related to the surgeons, including doubts about the competency of the surgeon and the perceived tendency of surgeons to promote surgery as the only real treatment option, according to the news release.

The researchers reported that surgeons generally do a good job of responding to patient concerns when they are raised. However, they also found that patients appear highly selective about what concerns they mention.

"Knowing that older adults frequently don't voice all their concerns should [encourage] surgeons to create opportunities for patients who are reluctant to bring them up," Frankel said.

The researchers also found that patients most often raised concerns when the surgeon was describing treatment recommendations and possible options. Surprisingly, few responses were elicited when surgeons asked, "Do you have any questions or concerns?"

In addition, white patients were about four times more likely to express concern about their physical well-being and "going under the knife" than African-American patients, according to the press release.