Transtheoretical Model Stage of Change in Surgical Decision-Making

Rationale for the Contemplation Stage

The patient is in the Contemplation stage, where individuals are aware a problem exists and are seriously considering taking action but have not yet made a commitment to act, as they are weighing the pros and cons of knee surgery and are uncertain about proceeding 1

The Contemplation stage is characterized by awareness and consideration of the problem, unlike the Pre-contemplation stage where patients are not yet considering change and may be unaware or in denial about the problem 1
The Preparation stage involves patients who have made a decision and are planning concrete steps toward action, which is distinct from the Contemplation stage where the patient remains hesitant and is still gathering information 1
The Action stage involves patients who have already modified their behavior or undergone the intervention, unlike the Contemplation stage where the patient has not committed to surgery and is still in the decision-making phase 1

The surgeon's role in the Contemplation stage is to facilitate shared decision-making by providing balanced information about both performing and not performing surgery, according to the American College of Rheumatology and American Association of Hip and Knee Surgeons guidelines 1

Presenting advantages and disadvantages of both surgery and conservative management in a balanced manner is crucial, as recommended by the American College of Rheumatology 1
Explicitly discussing the risks of not operating, particularly when delay carries risk of irreversible consequences, is essential for informed decision-making, as emphasized by the American College of Rheumatology and American Association of Hip and Knee Surgeons 2, 1

Delaying knee surgery can lead to increased pain and loss of function in patients with moderate-to-severe osteoarthritis, according to the American College of Rheumatology 2, 3
Delaying surgery can also worsen medical comorbidities due to limited mobility, as reported by the American College of Rheumatology 2, 3
The 2023 ACR/AAHKS guidelines emphasize that there should be no arbitrary waiting period mandated before surgery, as patients have typically already attempted nonoperative treatment for an extended period, highlighting the importance of individualized decision-making 2, 3