Patient and surgeon perspectives on shared decision-making in hip and knee osteoarthritis treatment: a qualitative exploratory study

Background: Navigating the various surgical and non-surgical options for treating osteoarthritis (OA) presents a significant challenge for patients. Determining the optimal treatment involves carefully weighing each option’s benefits, risks, and consequences. What constitutes the “best treatment”—whether surgical or non-surgical—is often subjective and shaped by individual circumstances and personal preferences. While shared decision-making, supported by in-consult patient decision aids, has proven valuable in helping patients and clinicians clarify values and choose the most suitable treatment, its integration into orthopaedic consultations remains limited. This study aims to identify the key decision-making factors relevant to patients and surgeons in the context of hip or knee OA. Methods: This qualitative exploratory study involved 15 field observations guided by the five-item Observing Patient Involvement instrument and two focus group discussions (FGs) with patients (n = 14) and their relatives (n = 4) and two (FGs) with orthopaedic surgeons (n = 12). The data were analysed using thematic analysis. Results: Field observations revealed variations in consultation practices, particularly in duration, information sharing, and patient-surgeon dynamics. FGs identified six main themes influencing treatment decisions. Patient-derived themes emphasized the critical role of the patient-surgeon relationship in building confidence, the importance of weighing treatment options, and the long decision-making process that often led patients to delay their appointment with the surgeon until they felt surgery was their only option. Surgeon-derived themes highlighted the need for more standardised information, scepticism about the shared decision-making approach, and concerns that patients with predefined treatment decisions might hinder the shared decision-making process. Conclusions: This study underscores the complexity of decision-making for patients with severe hip or knee OA, highlighting factors such as symptom severity and trust in healthcare providers. Its findings suggest a need for a more standardised approach to information delivery and the implementation of shared decision-making to improve patient satisfaction with joint replacement outcomes. Introducing in-consult patient decision aids earlier in the decision-making process could help prepare and inform patients.