Division of Geriatrics, Yale School of Medicine, New Haven, Connecticut.
Department of Human Development, Cornell University, Ithaca, New York.
J Gerontol B Psychol Sci Soc Sci. 2018 Mar 2;73(3):387-398. doi: 10.1093/geronb/gbw023.
The present study investigates age differences in the types of decision support that total joint replacement (TJR) candidates desire and receive when making the decision to pursue surgery. We consider the social structural (relationship to the patient) and experiential factors (network members' experience with TJR) that influence individuals' support preferences and the interactions of these factors with age. We also examine whether a lack of support is linked with increased decisional conflict and reduced willingness to undergo surgery.
A telephone survey was conducted with 100 individuals (aged 40+) who were contemplating knee or hip replacement.
TJR candidates desired and received decision support from health care providers, family members, and individuals who had previously undergone TJR. They reported higher deficits in informational and emotional support than in instrumental support. Overall, a lack of instrumental support was associated with greater decisional conflict; a lack of instrumental support and a lack of informational support were associated with reduced willingness to undergo TJR.
Our findings point to the importance of involving both formal and informal network members in TJR discussions, and the need for informational guidance and practical assistance to reduce decisional conflict and uncertainty among individuals considering TJR.
本研究调查了全关节置换 (TJR) 患者在决定接受手术时，对不同年龄人群所需和获得的决策支持类型的差异。我们考虑了影响个体支持偏好的社会结构（与患者的关系）和经验因素（网络成员的 TJR 经验），以及这些因素与年龄的相互作用。我们还研究了缺乏支持是否与决策冲突增加和手术意愿降低有关。
对 100 名（年龄在 40 岁以上）考虑膝关节或髋关节置换的患者进行了电话调查。
TJR 候选者希望并获得了来自医疗保健提供者、家庭成员和之前接受过 TJR 的个体的决策支持。他们报告说，在信息和情感支持方面的缺陷比在工具支持方面更为严重。总体而言，缺乏工具支持与更大的决策冲突有关；缺乏工具支持和信息支持与降低接受 TJR 的意愿有关。
我们的发现表明，在 TJR 讨论中，既需要包括正式网络成员，也需要包括非正式网络成员，并且需要提供信息指导和实际帮助，以减少考虑 TJR 的个体的决策冲突和不确定性。
