JMIR Publications

ABSTRACT

Background:

Degenerative meniscus findings are common in middle-aged and elderly adults, and current guidelines favor nonoperative care. As patients increasingly turn to portal systems to view imaging results and communicate with their physician, patient-facing wording may shape downstream treatment preferences and expectations.

Objective:

To determine whether subtle differences in physician message framing about an identical degenerative meniscus tear influence: preferred management; expectations for improvement with conservative therapy; and satisfaction when a physician recommends a different plan.

Methods:

A cross-sectional 37-question survey was developed de-novo and distributed in January 2026 to U.S. lay adults (≥18 years) recruited via Amazon Mechanical Turk. Respondents were presented with a standardized vignette of a 60-year-old adult with knee pain due to a degenerative meniscus tear. Participants were randomized in 1:1:1 fashion into three physician portal-message framing groups: Neutral, Degenerative, Damage. Outcomes were preferred next step in treatment, expected improvement with physical therapy, and retained satisfaction under physician-respondent disagreement. Chi-square tests and Fisher exact tests were used to compare categorical variables. Multivariable logistic regression analyses were employed to assess associations between framing groups.

Results:

Of the 266 completed responses, 195 were included for analysis (Neutral n=67; Degenerative n=63; Damage n=65). Treatment preferences differed significantly across groups (χ²(2) = 6.105, p=0.047), and the Damage group was significantly more likely to prefer aggressive interventions (OR 2.43, 95% CI 1.17-5.06; p=0.019). Expectations for physical therapy success differed significantly (χ²(4)=12.27, p=0.015), with the Damage group being most pessimistic about conservative care. Retained satisfaction under physician disagreement did not differ by framing group (χ²(6)=6.68, p=0.351), but did differ significantly by initial treatment preference (p=0.028), and was lowest among respondents preferring steroid injection.

Conclusions:

In this exploratory investigation, subtle differences in physician portal-message framing regarding an MRI impression of a degenerative meniscus tear were associated with shifts in treatment preferences and confidence in conservative care. These findings suggest that brief physician portal communications may be associated with shifts in hypothetical patient expectations and treatment preferences before clinical counseling occurs.