Patience, known as Pat, is in her mid-50’s, has a learning disability, and wears hearing aids in both ears. She has osteoarthritis of the hip that causes her pain, limits mobility, and is reducing her quality of life. 

Pat was referred to the orthopaedic team for treatment for her hip. The orthopaedic team referred her for IMCA support from POhWER because they had been unable to involve her in discussions around possible treatment options as she struggled to understand the medical information they were giving her.

Brian, a POhWER advocate, got information from the medical team about Pat’s treatment options and the risks/benefits of each. A full hip replacement was the recommended option for the best outcome, but this depended on Pat understanding the importance of engaging with post-operative physiotherapy to ensure successful rehabilitation. 

Brian then spoke to the care staff that help to look after Pat to find out what specific communication needs she has. Due to having a learning disability and hearing impairment, Pat needs information in image format with short simple words to help her to understand.

Using this information, Brian created a pictorial story board which he used to talk to Pat in simple terms about her treatment options, the implications of each, and the importance of physiotherapy should he decide to have an operation. 

The story board explored three options:

• having surgery for pain removal (Girdlestone procedure)
• having surgery for pain relief and improved mobility (Full hip replacement)
• or no surgery and regular injections for pain reduction instead.

It also explained the aftercare required for each.  

Pat was able to communicate to Brian that being mobile and pain free was very important to her, she understood the basics of an operation and spending time in hospital, and that she would need to do exercises to help her walk again after the procedure. Pat said she would prefer a full hip replacement to ending up dependent on a wheelchair.  

Brian then asked Pat to follow his instructions to copy a range of basic exercises. She was able to do this successfully when the information was given in a simple and practical way.

Brian was then able to share this information with Pat’s orthopaedic team and demonstrate:

• she had sufficient understanding for her views to be taken into account
• she was willing and able to engage with physiotherapy to ensure good chance of successful rehabilitation if the instructions were of an appropriate format for her to understand.

Pat told Brian "I am so pleased you helped me understand. I am not scared anymore and want to have the operation and help myself get better again".  

Advocacy support helped Pat to be involved in the decision-making process for her medical treatment, and her views will be taken into consideration. Pat will be given access to surgical intervention on the same basis as anyone else and not disregarded due to concerns that she might not be able to follow post operative instructions. Once surgery is undertaken (she is on the waiting list), Pat will have the best chance of being pain free, retaining independent mobility, and maintaining her quality of life.