# An Exploration of the Content and Language Used in Publicly Available National Health Service Patient Information Leaflets for People Considering Shoulder Replacement Surgery: A Qualitative Study

## TL;DR

This study examines NHS patient information leaflets for shoulder replacement surgery to see if they help patients make informed decisions.

## Contribution

The study reveals that NHS leaflets often lack balanced information about non-surgical options and may not support shared decision-making.

## Key findings

- NHS leaflets mainly present shoulder pathology from a clinician's perspective.
- Few leaflets discuss non-surgical treatments, often portraying them as temporary.
- The content and language may not adequately support informed surgical decisions.

## Abstract

The decision to undergo total shoulder replacement surgery is a major one and should be a joint one between the patient and surgeon. It is important that patients are provided with accessible, meaningful and appropriate information to enable an informed decision. The aim of this study was to explore the content and language used within publicly available information leaflets produced by UK National Health Service (NHS) Trusts for people considering shoulder replacement surgery and to consider how this may influence surgical decision making.

An online search of publicly available NHS shoulder replacement patient information leaflets (PIL) was undertaken. The text within the PIL was analysed using reflexive thematic analysis.

Thirty‐eight PIL were identified. The volume of information and content varied greatly. All PIL discussed the clinical problem, mainly within a biomedical framework and from a clinician's perspective in which normal shoulder anatomy was contrasted with shoulder pathology. Only a minority of the PIL discussed non‐surgical treatments and of those that did, such approaches were predominantly portrayed as a temporary management option only, whilst surgery was frequently portrayed as the optimum treatment.

There is variation in the content of NHS shoulder replacement PIL. The content and language used may not adequately support people in making an informed decision about whether surgery is the right treatment option for them. We need to better understand the information needs of people considering shoulder replacement surgery, and provide information that is accessible, culturally sensitive, and capable of facilitating shared decision making.