Transtheoretical Model Stage of Change: Contemplation Stage
This patient is in the Contemplation stage of change, where she is aware that knee surgery has been recommended and is seriously considering it, but remains hesitant due to fear of surgical complications and uncertainty about the risks of not proceeding with surgery. 1, 2
Understanding the Contemplation Stage
The Contemplation stage is characterized by specific features that distinguish it from other stages:
The patient acknowledges the problem exists (knee problems requiring surgical intervention) and is actively weighing the pros and cons of taking action, but has not yet committed to proceeding 1
She is aware of the recommendation but is experiencing ambivalence—specifically fear of surgical complications while simultaneously being "unaware about complications if she will not do the surgery" 2
This represents the classic contemplation dilemma: the patient wants to change "someday" but is not yet ready to act, stuck in the decision-making phase 1
Why This is NOT Other Stages
Pre-contemplation Stage
- Pre-contemplation is when a person has no interest in changing the behavior and may be unaware or in denial about the problem 1
- This patient clearly recognizes the problem and is considering surgery, ruling out pre-contemplation 2
Preparation Stage
- Preparation occurs when a patient has already made the decision and is planning concrete steps toward action, needing only assistance to move that decision into reality 1
- This patient has not committed to surgery and remains in active decision-making, not preparation 2
Action Stage
- Action involves patients who have already modified their behavior or undergone the intervention 1
- This patient has not proceeded with surgery, clearly excluding the action stage 2
Clinical Implications for the Provider
The provider's role in the Contemplation stage is to facilitate shared decision-making by providing balanced information about both performing and not performing surgery. 2
Key Communication Strategies
Present both advantages and disadvantages of surgery AND conservative management in a balanced manner 2
Explicitly discuss the risks of not operating, which this patient is currently unaware of—this is critical for informed decision-making 2
Address her specific barrier: fear of surgical complications. In Contemplation, the intervention should identify and focus on removing patient barriers 1
Information to Address Her Knowledge Gap
The provider should educate her that delaying knee surgery can lead to:
Increased pain and loss of function in patients with moderate-to-severe osteoarthritis 2
Worsening medical comorbidities due to limited mobility 2
Further disability and chronic disease from prolonged pain and physical limitations 1
Common Pitfall to Avoid
Do not simply provide educational materials and schedule a follow-up. The Contemplation stage requires active engagement to identify and address her specific barriers (fear of complications) and fill her knowledge gaps (risks of not operating) to move her toward the Preparation stage 1, 2