Expectations of total knee and hip arthroplasty patients: a multimethod study.

Total knee and hip arthroplasty (TKA and THA) are common surgical procedures
for end-stage arthritis. Although TKA and THA have high clinical success rates,
up to 19% of patients report some degree of dissatisfaction after surgery.
Several studies show that (i) fulfilment of expectations is the most important
predictor of satisfaction; and (ii) expectations are overly optimistic. Authors
of these studies suggest that patient expectations about the outcome of TKA/THA
should be targeted explicitly during the pre-operative doctor-patient
consultation. However, as far as we know, no studies have been performed to
examine doctor-patient communication with regard to expectations. The first
objective of the current study is to increase the understanding of
doctor-patient communication and the management of pre-operative patient
expectations by observing and analyzing the pre-operative doctor-patient
consultation. Furthermore, the process of targeting unrealistic expectations
might be even more efficient is the surgeon knows which patients are
particularly vulnerable for having unrealistically high expectations. Several
patient-related factors are known to predict higher expectations in TKA and THA
patients. However, research has been mostly limited to demographic and clinical
variables, while psychological variables have been studied less. The second
objective of the current study therefore is to study the relationship between
patient-related factors and expectations, with the focus on psychological
variables. The acquired knowledge will probide guidelines for adequate
expectation management during the doctor-patient consultation, which in turn
may increase patient satisfaction.

The main objectives of the current study are to (i) examine whether fulfilment
of expectations predicts patient satisfaction in a Dutch sample of TKA and THA
patients; (ii) study which patient-related factors predict unrealistically high
patient expectations; and (iii) explore to what extent and in what way
expectations about the outcome of TKA/THA are currently being discussed during
the pre-operative consultation. Secondary objectives of the study are (iv) to
explore which expectations patients have and which are most likely to stay
unfulfilled; (v) to examine the consensus between preoperative patient and
doctor expectations; (vi) to form a model that describes how (fulfilment of)
expectations, satisfaction, outcome of surgery, doctor-patient communication,
and the studied patient-related factors relate to each other; and (vii) to
explore what patients expect of the patient-doctor consultation.

The study has a multimethod design in which (i) the pre-operative
doctor-patient consultation will be videotaped and analyzed, and (ii) patients
will complete questionnaires at seven points in time between the moment before
the pre-operative consultation until 12 months after their surgery.

Patients will complete a questionnaire at 7 different points in time and will
be videotaped during the pre-operative doctor-patient consultation, so there is
no risk in participating in the study. However, the study will provide insight
in how pre-operative patient expectations are being managed during the
doctor-patient consultation. Furthermore, the study will give insight in the
influence of fulfilment of expectations on satisfaction with outcome of TKA/THA
and in which patient-related factors contribute to unrealistically high
preoperative expectations. With the knowledge obtained by the study, it is
possible to develop an intervention to target (those patients prone to) high
expectations, which in turn will increase satisfaction with TKA/THA.