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Journal of Long-Term Effects of Medical Implants
SJR: 0.133 SNIP: 0.491 CiteScore™: 0.89

ISSN Print: 1050-6934
ISSN Online: 1940-4379

Journal of Long-Term Effects of Medical Implants

DOI: 10.1615/JLongTermEffMedImplants.2014010918
pages 195-204

Musculoskeletal Health Disparities: Health Literacy, Cultural Competency, Informed Consent, and Shared Decision Making

Frank M. McClellan
Temple University Center for Health Law, Policy, and Practice, James E. Beasley School of Law, Temple University, Philadelphia, Pennsylvania
James E. Wood Jr
Department of Orthopaedic Surgery, MedStar Harbor Hospital, Baltimore, Maryland
Sherin M. Fahmy
Beasley School of Law, Temple University, Philadelphia, Pennsylvania
Lynne C. Jones
Johns Hopkins University, Center for Osteonecrosis Research and Education, Baltimore, Maryland


The factors that contribute to musculoskeletal healthcare disparities may influence the results of studies regarding the long-term outcome of orthopaedic implants. Patient decisions regarding their healthcare and their subsequent outcomes are influenced by health literacy. Providing patients with the information that they need to consent to treatment must be provided in a culturally competent manner. The influence of the physician or healthcare provider on the treatment choice varies depending on the type of decision-making process: patient-based, physician-based, or shared decision making. Respecting the patient's autonomy while acknowledging the knowledge and experience of the physician, we advocate for shared decision making. This may require modification of existing regulations regarding informed consent. Furthermore, federal and state directives have been put into place to address healthcare disparities, especially with respect to culturally competent care and access to proper healthcare.