Exploring patient’s decision making prior to shoulder arthroplasty
Research type
Research Study
Full title
Exploring patient’s decision making prior to elective shoulder arthroplasty
IRAS ID
294209
Contact name
Peter Reilly
Contact email
Sponsor organisation
Imperial College London
Duration of Study in the UK
0 years, 9 months, 0 days
Research summary
Shoulder pain is a common reason people visit their general practitioner and the number of shoulder replacements performed in England, Wales and Northern Ireland has doubled since 2012. A joint replacement is major surgery and it is associated with significant risks.
There are two main categories of shoulder replacement; anatomical shoulder replacements and reverse shoulder arthroplasty. Anatomical shoulder replacements are used in patients with advanced shoulder arthritis and where the muscles around the shoulder are working normally. They include total shoulder arthroplasty (TSA) and hemiarthroplasty. When the shoulder muscles aren’t functioning adequately but a joint replacement is required, reverse shoulder arthroplasty can be used to change the normal structure of the joint and provide satisfactory function. Each type of replacement has specific risks and benefits.
Our aim is to understand how patients with advanced arthritis of the shoulder decide whether to have a replacement, which type of replacement, and what information is most important to them. We plan to perform semi-structured interviews with patients with advanced arthritis of the shoulder joint who are planning to have a joint replacement. Interview scripts will guide the questions and there will be opportunities for open discussions. We will record and transcribe the interviews. These will be carefully reviewed to identify shared themes in the way patients make decision and explore their priorities.
Lay summary of study results:
Shoulder replacement (arthroplasty) is a good treatment for worn-out, arthritic shoulder joints, but it's major surgery with real risks and a long recovery. Doctors know a lot about the surgery's results, but less about how patients actually decide to go ahead with it, and what information matters most to them. This study set out to understand that.What the researchers did
They interviewed 12 patients on the waiting list for a shoulder replacement at two NHS hospitals in London. The patients ranged in age from 35 to 88 and included both men and women, chosen deliberately to capture a wide range of views. The interviews were recorded, written out, and carefully analysed to spot common themes.What they found
Two big things drove the decision to have surgery.
The first was getting rid of pain. Constant pain, especially pain at night that wrecked their sleep and left them exhausted, was the number one motivator. Over time it became so all-consuming that it outweighed people's fears about the operation itself.
The second was getting their life back. People wanted their independence: to wash their hair, get dressed, do jobs around the house, and stop relying on family. Younger patients focused on keeping their jobs, playing sport, and looking after their children. Older patients talked about not having much time left and wanting to make the most of it.Information and trust formed another key theme. Patients gathered information from websites, videos and animations (often ones made by hospitals), and conversations with people who'd had the operation. But many, once they'd learned the basics, were happy to trust their surgeon with the finer decisions. Trust in the surgeon was, for many, the most important factor of all. Younger patients struggled to find information relevant to their age, since most material was aimed at older patients, and they worried more about whether the new joint would wear out and need replacing later.
Why it matters
Pain relief and reclaiming everyday life are the main reasons people go through with shoulder replacement. The study shows how much the patient-surgeon relationship matters, and how important it is to give clear, accessible information tailored to a person's age and lifestyle, including practical recovery tips and stories from patients with similar needs.REC name
HSC REC A
REC reference
21/NI/0137
Date of REC Opinion
13 Aug 2021
REC opinion
Further Information Favourable Opinion