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Influence of Patients' Gender on Informed Decision Making Regarding Total Knee Arthroplasty
Author(s) -
Borkhoff Cornelia M.,
Hawker Gillian A.,
Kreder Hans J.,
Glazier Richard H.,
Mahomed Nizar N.,
Wright James G.
Publication year - 2013
Publication title -
arthritis care and research
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 2.032
H-Index - 163
eISSN - 2151-4658
pISSN - 2151-464X
DOI - 10.1002/acr.21970
Subject(s) - medicine , orthopedic surgery , confidence interval , informed consent , family medicine , physical therapy , total knee arthroplasty , osteoarthritis , interpersonal communication , medline , patient participation , alternative medicine , surgery , psychology , social psychology , pathology , political science , law
Objective To investigate the effect of patient gender on patient–physician communication in the process of recommendation for total knee arthroplasty (TKA). Methods Seventy‐one physicians (38 family physicians and 33 orthopedic surgeons) in Ontario performed blinded assessments of 2 standardized patients (1 man and 1 woman) with moderate knee osteoarthritis and otherwise identical scenarios. Four surgeons did not consent to including their data. Standardized patients and accompanying mock family members recorded elements of informed decision making (IDM) as present/absent in the patient–physician discussion and rated the physicians' interpersonal skills. Results Overall, the completeness of IDM was low, but was lower still for the woman. Only 57% (38 of 67) and 15% (10 of 67) of physicians discussed the nature of the decision and elicited the patient's preference while consulting with the man and woman, respectively. Even after adjusting for physicians' recommendations regarding TKA, when interacting with the woman, physicians included fewer IDM elements (adjusted mean difference in IDM score 1.2 [95% confidence interval (95% CI) 0.6, 1.8]; P < 0.001) and had poorer interpersonal skills (adjusted mean difference 14.1 [95% CI 9.0, 19.2]; P < 0.001) compared with their consultation with the man. Conclusion Physicians provided less medical information and less encouragement to participate in the decision to undergo TKA to a woman compared with a man, irrespective of their recommendation regarding TKA. Our findings suggest that in addition to directly influencing physicians' clinical decision making, gender bias may also influence physicians' interpersonal behavior.