‘Physio’s not going to repair a torn tendon’: patient decision-making related to surgery for rotator cuff related shoulder pain

Abstract

Background Rotator cuff related shoulder pain (RCRSP) is a common and disabling shoulder condition and surgical management is becoming more common. The rates and costs of surgical interventions have been on the rise. Understanding decision-making related to surgery and providing adequate information to people with RCRSP may improve patient-centred care and potentially reduce rates of surgery. Objectives To explore the decision-making processors of people who have undertaken surgery for RCRSP. Design An in-depth thematic analysis. Method Interviews were conducted with patients from Melbourne who had had surgical management for RCRSP. Data were analysed using an inductive thematic approach. Results Fifteen participants were recruited. Six key themes emerged: (1) Needing to get it done: “It was necessary to remedy the dire situation”; (2) Non-surgical treatment experience:” I knew that I’d done all I could”; (3) Mechanical problem:” Physio’s not going to repair a torn tendon”; (4) Trust in medical professionals “If they told me that I needed to swallow a thousand spiders, I would have done it.”; (5) Varied information sources “Dr Google played a big part in it”; (6) Organisational barriers “It was absolutely useless, my insurance.” Conclusion Surgery appears to be commonly precipitated by unremitted severe symptoms and failed non-surgical treatment. While there was strong trust in highly trained surgeons, decision to undergo surgery also drew on questionable pathoanatomical beliefs and instances of inadequate patient information about treatment choices and risks that may be addressed by adopting a more patient-centred care approach. IMPLICATIONS FOR REHABILITATION Understanding decision-making related to surgery and providing adequate information to people with rotator cuff related shoulder pain may improve patient-centred care. Surgery appears to be commonly precipitated by unremitted severe symptoms and failed non-surgical treatment. Decision to undergo surgery sometimes drew on questionable pathoanatomical beliefs. There was strong trust in highly trained surgeons but there were instances of inadequate patient information about treatment choices and risks.