Psychosocial Factors Are Associated With Risk Acceptance in Upper Extremity Patients.

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.