Developing a communication checklist to enhance patient satisfaction with total knee replacement surgery: a mixed methods study

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University of New Brunswick


Total knee replacement (TKR) surgery improves patients’ quality of life by reducing pain and increasing function. However, up to 20% of patients are reportedly dissatisfied. The goal of this study was to develop a communication checklist to enhance the quality of surgeon-patient communication, which was hypothesized to increase TKR satisfaction via the management of patients’ post-operative expectations. The mixed methods research design began with a qualitative study of eight participants who were interviewed about their recovery. The results of two qualitative analyses contributed to the development of the Orthopaedic Surgery Outcome Communication Checklist, which four surgeons used in a community hospital setting to guide discussions with their patients about progress, expectations, and outcomes in post-operative clinic visits up to 6 months. In the subsequent, quantitative study, 60 patients received the checklist intervention in their follow-up visits from 6 weeks up to 6 months post-operatively. Their self-reported satisfaction after 6 months was compared with 67 patients who received the usual standard of care communication and had been surveyed prior to the checklist development. The checklist patients reported significantly higher satisfaction on four of five measures of satisfaction: overall satisfaction and expectations met (p = .02); surgeons’ communication ability (p = .01); care and concern shown by the surgeon (p = .01), and satisfaction with the amount of time surgeons spent in post-operative follow-up visits (p < .001). Satisfaction with relief from pain and return to function was not significant (p = .06). A random sample of the duration of post-operative follow-up visits was recorded. The mean difference between the two groups was 1 minute, 51 seconds, indicating significantly more time was spent in the checklist groups’ follow-up visits (p = .001). The communication checklist has practical significance because patient satisfaction is a metric that is increasingly being used as a key performance indicator for surgeons and health care institutions alike. Furthermore, the need for TKR surgery in Canada is expected to rise dramatically over the coming decades due to obesity and our aging population. Greater TKR satisfaction will benefit patients, surgeons, and the health care system overall.