Improving Patient Comprehension Should Always Be a Top Priority in Orthopaedic Surgery

Patients need a clear understanding of their health conditions and treatment options to manage their health and make informed decisions about their care. Patient comprehension refers to a patient’s ability to understand and retain information provided by a healthcare professional, including details about illnesses or conditions, diagnostic procedures, treatment options, and the potential risks and benefits of those options. This also includes self-care instructions and lifestyle modifications that may be recommended.

Lack of patient comprehension or participation with care is expensive. The estimated costs of hospitalization due to medication nonadherence are $13 billion annually in the United States alone, where nonadherence has become a risk factor for a range of poor health outcomes that include more than 125,000 deaths each year. Nearly 40 percent of patients sustain significant risks by misunderstanding, forgetting, or disregarding healthcare advice, and nonadherence rates are at almost 70 percent when complex preventive or treatment regimens and lifestyle modifications are recommended.

Health literacy regarding orthopaedic pathologies can be challenging for patients, and low health literacy can lead to misunderstandings and poor perceptions of care. In a single-center, prospective study of 21 patients, Giudici et al measured patient comprehension of information provided during a surgical consultation prior to a scheduled surgery. The authors determined that there is a variation between perceived and actual understanding, with patients overvaluing some information (e.g., reasons for the intervention and alternatives to surgery), whereas other information, such as risks and complications of a surgery, was not understood or not provided (e.g., postoperative follow-up information).

Establishing strong physician-patient relationships can enhance patients’ knowledge and insight about their diagnoses and treatment options. This relationship is essential when discussing various therapeutic options so that patients feel they are an active partner in their own care and possible outcomes. Improved patient comprehension about symptoms, diagnosis, and treatment options allows them to make better-informed decisions and improve the effectiveness of treatment and overall health outcomes. If patients understand their pathology and options, they may be able to manage their expectations and their symptoms more appropriately.

To improve patient knowledge and insight about a condition, physicians should use clear and simple language, avoid or limit technical terms and medical jargon, provide visual aids such as diagrams or models, and encourage questions from patients and their family members. In a cross-sectional study that aimed to identify patient comprehension of common orthopaedic terminology across multiple hospital settings, Cosic et al utilized questionnaires to measure total comprehension and concluded that patients seen in the emergency department and/or admitted to the hospital demonstrated poor comprehension of orthopaedic terminology. Additionally, to facilitate better patient comprehension, the authors insisted that healthcare professionals should assume a poor level of comprehension during their interactions and provide clear and concise instructions and expectations. It is imperative to understand that what strikes a healthcare professional as common medical vernacular is often still unfamiliar to many patients.

Patient radiographs can be a very effective visual tool to enhance comprehension. It can be beneficial for a patient to bring a trusted friend or family member to the appointment to help record important information or ask clarifying questions. Lastly, repeating or summarizing important information and asking patients to repeat back important information can help ensure that it is understood and retained. Providing patient handouts from a trusted source may also give patients an opportunity to continue learning about their condition at home, allowing them further insight into treatment options and management.

Newer methods to address health literacy have included novel digital technologies such as interactive infotainment systems. Huang et al utilized video demonstrations that described precautions for the pre- and postoperative course of surgery and what patients should expect from physical therapy and wound care. Although the study resulted in a shorter hospital course for patients, more studies are needed to demonstrate how effective this modality can be.

Despite utilizing all of the aforementioned modalities, it is difficult to correlate a patient’s comprehension with their compliance. Patient noncompliance can take many forms if the advice provided by healthcare professionals is either misunderstood, executed incorrectly, forgotten, or ignored. The authors believe that patient understanding is the initial step to compliance with recommended treatments. By providing the necessary education to patients, surgeons can demonstrate the importance of compliance with postoperative instructions and recommendations to achieve a mutually successful outcome (see Sidebar).

As patient noncompliance is a known source of increased healthcare spending, the authors recommend that future studies examine patient understanding among a diverse population prior to and after treatment. Additionally, interpersonal and cognitive factors and cultural variations must be considered when constructing such models. Studies should examine orthopaedic surgeons’ ability to teach patients about complex pathologies while ensuring that patients understand their diagnosis and management.

John M. Tarazi, MD, is an orthopaedic surgery resident at Northwell Health Huntington Hospital in Huntington, New York.

Amanda Fantry, MD, is an orthopaedic surgeon at Advanced Orthopedics in Hartford, Connecticut, with fellowship training in foot and ankle surgery. She is an active member in AAOS and the American Orthopaedic Foot and Ankle Society.

Adam D. Bitterman, DO, FAAOS, is a board-certified orthopaedic surgeon and an assistant professor of orthopaedic surgery at the Donald and Barbara Zucker School of Medicine at Hofstra/Northwell. He is chairman of orthopaedic surgery at Northwell Health Huntington Hospital and associate program director for the orthopaedic surgery residency program. He is a foot and ankle specialist and has a focus in treating conditions of the lower leg.

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Suggestions to help improve patient comprehension

• Establish a strong physician-patient relationship.
• Educate patients clearly and effectively by encouraging questions and implementing a read-back technique to solidify understanding.
• Encourage patients to bring a family member or friend to an appointment to help record information or ask questions, particularly when treatment decisions are anticipated.
• Use clear and simple language by providing visual aids such as diagrams or models to improve patient knowledge and insight about a condition.
• Include the patient in the decision-making process to increase patient compliance with the treatment selected.
• Repeat or summarize important information and ask the patient for a read-back to help ensure that it is understood and retained.
• Consider video demonstrations, which can detail the operative course, including pre- and postoperative events, wound care, and expectations with physical therapy.