Understanding the treatment journey and experiences of knee osteoarthritis patients receiving standard care in Singapore: a qualitative study.

backgroundA treatment journey (TJ) outlines a patient’s needs, actions, and experiences when seeking treatment. In Singapore, the quality of knee osteoarthritis (KOA) care is suboptimal. Mapping the TJ of older KOA patients can identify gaps in care influencing treatment decision, experiences, timeliness, and effectiveness for optimizing care in Singapore.

methodsThis qualitative study was embedded in a larger qualitative study conducted in an urban, referral-based tertiary hospital in Singapore that evaluated and explored KOA patients’ treatment experiences of a randomized controlled trial. The larger study conveniently sampled 46 patients (22 intervention, 24 control). Semi-structured interviews were conducted in a quiet private hospital room. Framework analysis was used to analyze all 24 control patients’ transcripts. There was sufficient information power to fulfill the study’s objectives.

findingsEighteen participants described relatively linear TJs comprising five sequential stages. Themes and sub-themes related to the stages are discussed. ONSET: Participants gained awareness as symptoms impacted their daily lives, alongside sense-making processes shaped by beliefs that KOA was an inevitable consequence of ageing. A strong need to cure their condition drove informal knowledge-seeking from social networks. SELF-TREATMENT: Participants experimented with topical agents, supplements, traditional Chinese medicine, analgesics, and exercise, often delaying formal care until symptoms worsened. Symptomatic exacerbation or persistence triggered treatment-seeking. PRIMARY CARE: Many participants felt dissatisfied with and dismissed from receiving limited explanations, passive management, and gatekept from specialist care. TERTIARY CARE: Orthopedic consultations gave participants hope in conservative physiotherapy treatment and position surgery as a last resort. Positive treatment experiences and symptom improvement fostered hope, confidence, and treatment engagement. Conversely, dissatisfactory experiences led some participants to disengage from treatment and question its relevance and value. POST-TREATMENT: Participants transitioned to self-management. Engagement in exercise and physical activity was motivated by the desire to avoid pain, deterioration, and surgery, and to maintain independence. However, inertia and perceived lack of time emerged as barriers. COMPLEX TREATMENT JOURNEYS: Six participants experienced complex, non-linear TJs involving multiple and/or repeated healthcare touchpoints that caused confusion and frustration. DISCUSSION: Improving community knowledge of KOA could meet older KOA patients’ strong need for treatment information, which influences sense-making, self-efficacy, decisions, and eventually treatment length, complexity, effectiveness, and experience. Healthcare providers could provide informative communication and feedback that fulfill their patients’ expectations for both information and care, as well as their need for hope confidence, reassurance, help, and relief. Inertia and a lack of time can be counteracted by providing meaningful, manageable, and adaptable care.

conclusionInadequate communication from healthcare providers are pain points in a TJ. Pain history and severity, and degree of physical functioning and KOA knowledge can influence a TJ’s length and complexity.

trial registrationThis study, embedded in a larger study that qualitatively evaluated data from a randomized controlled trial (NHG DSRB ref no: 2020/00067) Tan et al. (BMC Musculoskelet Disord. 21(1):684, 2020) that explored the treatment experiences of KOA patients, is not a clinical trial (clinical trial number: not applicable).