Psychosocial Factors Are Associated With Risk Acceptance in Upper Extremity Patients

Abstract

Objective Patients who help choose their health strategies are more adherent and achieve better health. An important role of the clinician is to verify that a patient’s expressed preferences are consistent with what matters most to the patient and not muddled by common misconceptions about symptoms or conditions. Patient choices are influenced by estimation of the potential benefits and potential harms of a given intervention. One method for quantifying these estimations is the concept of maximum acceptable risk (MAR), or the maximum risk that subjects are willing to accept in exchange for a given therapeutic benefit. This study addressed the hypothesis that misconceptions due to unhelpful cognitive bias regarding pain are associated with risk acceptance among people seeking care for an upper extremity condition. Methods We invited 140 new adult patients visiting an upper extremity specialist to complete a survey including demographics, pain intensity, depression and anxiety symptoms, catastrophic thinking, activity limitations, and MAR. Trauma or nontrauma diagnosis was obtained from the treating clinician and recorded by the research assistant. We used bivariate and linear regression analyses to identify factors associated with MAR among this population. Results Accounting for potential confounding in multivariable analysis, higher MAR was associated with older age and greater catastrophic thinking. Conclusions Specialists can be aware that people with more unhelpful cognitive biases may be willing to take more risk. Vigilance for common misconceptions and gentle, incremental reorientation of those misconceptions can increase the probability that people will choose options consistent with what matters most to them.

Do Unhelpful Thoughts or Confidence in Problem Solving Have Stronger Associations with Musculoskeletal Illness?

“…The observation that greater pain intensity was associated with greater worst-case thinking but not with levels of past and current ability to achieve goals or confidence in problem solving suggests that the same concepts hold true for symptom intensity. Specific measures of unhelpful thoughts (catastrophic thinking, in this case) may provide adequate information about mental health opportunities [5,13,35,36,38]. If additional research confirms these relationships, it may greatly simplify how we measure and address mental health in specialty care.…”

Do surgeons postpone offer of discretionary surgery when patients are experiencing difficult life events?

“…People often accommodate long‐standing, gradual onset disease until stressful circumstances bring it to their attention, and this may contribute to a perceived need for treatment 3–5 . Because unhelpful thoughts about pain are associated with both greater incapability and greater willingness to accept risk, 4,6,7 having a recent DLE may increase the probability that a patient will consider discretionary surgery 8 . A decision for operative treatment made under stress may be more likely to be distorted by unhelpful thoughts (e.g., the notions that new pain indicates injury, that painful activities will make the problem worse, or that one cannot continue in cherished roles and activities while experiencing pain) and might be less likely to align with what matters most to a patient (their values), which might, in part, explain an association with less favourable recovery trajectories 1,9–13 .…”