JMIR Publications

ABSTRACT

Background:

Degenerative meniscus findings are common in middle and older 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 influences: preferred management; expectations for improvement with conservative therapy; and satisfaction when a physician recommends a different plan.

Methods:

A prospective, randomized, cross-section 37-question survey was distributed to U.S. lay adults recruited via Amazon Mechanical Turk. Respondents were presented with a controlled vignette, putting them in the position of a 60-year-old patient with knee pain due to a degenerative meniscus tear. Participants were randomized 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 in a follow-up scenario in which the treating physician disagreed with a respondent’s treatment preference.

Results:

Of the 266 completed responses, 195 were included for analysis (Neutral n=67; Degenerative n=63; Damage =65). Treatment preferences differed significantly across groups (χ²(2) = 6.105, p = 0.047). The Damage group was more likely to prefer aggressive interventions (n/N=48/65, 58.7%) compared to the Neutral (n/N=36/56, 53.7%) and Degenerative groups (n/N=37/63, 58.7%). Damage framing significantly increased the odds of a respondent preferring invasive options (OR 2.20, 95% CI 1.15-4.23; p=0.012). Expectations for physical therapy success differed significantly (χ²(4)=12.27, p=0.015), with the Damage group being most pessimistic about conservative care versus the Neutral and Degenerative groups. 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:

Patient-portal message framing about an identical meniscal MRI finding significantly shifted management preferences and confidence in conservative therapy. Avoiding pathologizing language may help support guideline-concordant care and reduce pessimism toward beneficial conservative therapy.