Stage of Change: Pre-Contemplation
This patient is in the Pre-Contemplation stage of change. She has been advised to undergo surgery but is unaware of the risks of not having the procedure, which is the defining characteristic of pre-contemplation—lack of awareness or engagement with the problem and its consequences 1, 2.
Rationale for Pre-Contemplation Classification
The patient demonstrates the hallmark features of pre-contemplation:
Lack of awareness of non-surgical risks: She is "unaware about complications if she will not do the surgery," indicating she has not fully engaged with understanding her condition's natural progression 1.
Fear without informed understanding: While she expresses fear of surgical complications, this represents an emotional barrier rather than informed decision-making, which is characteristic of someone who has not yet contemplated the full scope of their situation 1, 2.
Not actively considering treatment options: True contemplation requires weighing both the risks of action AND inaction. This patient is only focused on surgical fears without understanding the alternative pathway 1, 3.
Why This Is NOT Contemplation Stage
Contemplation stage requires:
Awareness of the problem and its consequences: Contemplators acknowledge concern about their condition and understand what happens without treatment 1.
Active weighing of pros and cons: Contemplators are "actually thinking about" treatment options and their alternatives, not just reacting with fear 4, 3.
Recognition of diagnosis significance: In the osteoporosis literature, contemplative patients were more likely to acknowledge their diagnosis and express concern about their condition 1.
This patient lacks these elements—she is reacting emotionally to surgical risk without understanding the competing risk of disease progression 1.
Clinical Implications
For pre-contemplative patients with knee pathology requiring surgery:
Education is the primary intervention: She needs information about the natural history of her knee condition without surgical intervention, including progressive disability, pain, and quality of life deterioration 5, 6.
Shared decision-making requires informed understanding: Current guidelines emphasize that discussions about surgery must include "benefits and risks related to surgery, and the alternatives to surgery" 5.
Risk assessment tools should be presented: For surgical candidates, presenting objective data about outcomes with and without surgery can move patients from pre-contemplation to contemplation 5.
The goal is to move her from pre-contemplation (unaware of non-surgical risks) to contemplation (actively weighing surgical versus non-surgical risks) before she can make an informed decision 1, 3.