Contemplation Stage
This patient is in the Contemplation stage (Option A), where they are aware that surgery has been recommended but remain hesitant and fearful, actively weighing the decision without yet committing to action. 1
Understanding the Contemplation Stage
The Contemplation stage is characterized by:
- Awareness of the problem and recommended intervention but lack of commitment to proceed 1
- Active consideration of pros and cons while experiencing significant ambivalence about the decision 2
- Fear and uncertainty serving as barriers to moving forward, particularly regarding potential complications 3
- Information-seeking behavior about both the risks of surgery and the consequences of not proceeding 1
Why This is NOT Other Stages
Pre-contemplation (Option D) is incorrect because:
- Pre-contemplation patients are unaware of the problem or in denial, not yet considering any change 1
- This patient clearly acknowledges the doctor's recommendation and is actively thinking about it 1
Preparation stage (Option B) is incorrect because:
- Preparation involves having made a decision and planning concrete steps toward action 1
- This patient has not committed to surgery and remains in the decision-making phase 1
Action stage (Option C) is incorrect because:
- Action involves patients who have already undergone the intervention or modified their behavior 1
- This patient has not proceeded with surgery 1
Clinical Implications for Managing This Patient
The physician's role at this stage requires specific communication strategies:
- Provide balanced information about both performing and not performing surgery, explicitly presenting advantages and disadvantages of each option 4, 1
- Explicitly discuss the risks of not operating, particularly when delay carries risk of irreversible consequences such as progression of disease, increased complications, or worse outcomes 4, 5
- Address the patient's fear directly by providing clear information about what to expect, as uncertainty about symptoms and outcomes is a primary driver of patient anxiety 3
- Avoid steering the patient toward a particular decision by explicitly stating that "different people make different choices" 4
Critical Information That Must Be Disclosed
To facilitate informed decision-making, the surgeon must:
- Present the purpose of the surgery, expected benefits, material risks, and alternative treatment options through a shared decision-making process 5
- Explicitly discuss what happens if surgery is not performed, including potential for disease progression, worsening function, or irreversible complications 4, 5
- Allow adequate time for patient questions and ensure comprehension of the information provided 5
Common Pitfall to Avoid
Do not treat this as mere "informed consent paperwork" - the patient's hesitation indicates they need genuine therapeutic engagement with their ambivalence, not just signature collection 5. The contemplation stage requires active exploration of the patient's specific fears and values before they can move toward a decision 2, 6.