How Rheumatoid Arthritis Patients Make Decisions Regarding Hand Reconstruction: A Qualitative Study from the Silicone Arthroplasty in Rheumatoid Arthritis Project.

Abstract

Previous studies have determined specific factors influencing patients with rheumatoid arthritis to choose to undergo reconstructive hand surgery. However, little is known about how rheumatoid arthritis patients are counseled by physicians regarding surgical options and the concerns that cause patients to decide not to undergo hand surgery reconstruction. The authors conducted a qualitative study to investigate the decision-making process rheumatoid arthritis patients undergo when deciding about surgical treatment, including the specific involvement from their physicians in the decision. Participants were recruited from the ongoing international collaborative Silicone Arthroplasty in Rheumatoid Arthritis study. Twenty semistructured interviews were conducted, and data were analyzed using grounded theory methodology. Eight of the 11 participants that underwent metacarpophalangeal joint arthroplasty indicated that improving hand function was the primary reason they chose to undergo surgery. Four of these participants were concerned about the aesthetics of their hands, whereas five of the eight participants who discussed their reasoning for not undergoing surgery felt aesthetics was not a good enough reason to undergo surgery. Three participants indicated that a negative perception of hand surgery by their rheumatologists discouraged them from the procedure. Finally, most (14 of 18) participants chose to make the final decision about surgery without involvement from their physician. The decision of whether or not to undergo surgery can be personal, and patients may prefer to make the final decision independently. It is important that rheumatoid arthritis patients receive collaborative counseling from their rheumatologists and hand surgeons to ensure they are making a knowledgeable decision.