The May 21, 2014 Orthopaedic Forum article, “Public perception regarding anterior cruciate ligament reconstruction” by Matava et al. is a timely reminder of how important physician-patient communication and patient education are.
In this study, 210 individuals (all but 7% of whom had a high school education and 50% of whom had a college degree) completed a predominantly multiple-choice questionnaire on their knowledge of anterior cruciate ligament (ACL) injury and its ramifications. Given the extensive media coverage of ACL injury in high-profile athletes, I think virtually everyone has heard the term “ACL.” But this study points out how superficial or incorrect patient knowledge is about ACL injury, even in this well-educated study cohort.
I urge you to read the article to see all the interesting findings, but here are a few of the most intriguing ones:
- 51% of factual questions were answered correctly.
- There was no correlation between education level and correct responses, but those with a higher activity level had a higher score on the survey.
- 16 participants with prior ACL injury had no more correct responses than those with no knee injury.
- 34% knew that the ACL was attached to bone at each end.
- 70% did not know that the risk for ACL injury is different between men and women.
- 48% thought that a complete ACL tear could heal without surgery.
- 33% thought ACL repair was needed to be able to walk.
- 32% thought ACL reconstruction surgery involved repairing the torn ligament.
While this article focused only on patient knowledge of ACL injury, the implications probably extend to essentially all orthopaedic surgical procedures. The push for us to use more shared decision making in deciding whether or not a surgical procedure is done requires that the patient has adequate information to make an informed decision. Unfortunately, the dearth of knowledge about a common knee injury among the general public highlighted in this article is so dramatic that it seems unlikely that the individuals surveyed could participate realistically in shared decision making about ACL surgery.
With orthopaedic procedures accounting for about 40% of CPT codes, it would be a huge challenge for orthopaedic practices to provide evidence-based education on all conditions prior to or during a discussion of possible surgical treatment. However, this article points out the need for much-improved patient education. Each orthopaedic practice will handle this differently, but perhaps when surgery is recommended, the physician extenders in an orthopaedic practice could suggest reliable websites through which patients can obtain information. The patients could then return with a list of questions that arose from their reading to be addressed during the final discussion related to surgical treatment.
However patient information is provided, this article points out the need for ongoing attention to filling the knowledge gap to realistically allow patients to be true participants in deciding which course of treatment is best.
Thanks, Vern, for calling this to our attention. I agree that depite our efforts patients are often poorly informed when deciding whether or not to have surgery. They are also poorly informed about what to expect if they have a complication. Decision supports that present a balanced picture of what to expect from surgery, including the perspectives of patients that chose not to have surgery or who experienced a complication, would be helpful. High-quality decision aids are very time-consuming and expensive to produce, however, and it would be difficult to get a consensus on content from all orthopaedic surgeons.