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TRC16152
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July 10, 2019 at 9:49 AM Eastern Time

Interviewer: [Pause] Good morning. Is this Jessica?

Respondent: Yes, it is.

Interviewer: Hi there. Can you hear me okay?

Respondent: I can hear you.

Interviewer: Okay, I can see you. Are you able to see me as well?

Respondent: I can see you.

Interviewer: Terrific! Well then, we’re all set. I thank you for participating. I just want to give
you a couple of little notes, housekeeping things, and then, I’m going to turn this
conversation over to you. First of all, I just want to make sure that we’re here for
the right reasons. I understand you’ve had a total knee replacement surgery?

Respondent: Right.

Interviewer: Okay, we are good to go. Just so you understand what we’re here for, my name is
Cyndi. I’m an independent market research moderator which means I do these
conversations on a lot of different topics with a lot of different people. I get to
learn an awful lot from this job but it also means I’m independent. I don’t work for
the company who’s sponsoring this. I have no stake in what we learn here. There’s
nothing you could say that’s going to offend me. There is no right or wrong answers

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 or anything like that. Having said that, I should let you know that some of the
people who will be making decisions based on this conversation might be listening
to us. None of us know who you are. We know your first name. We know a few
things about you but there’s nothing that will be traced back to you so I hope you’ll
feel that you can give us candor and as much honesty as you’re willing to in this
conversation.

Respondent: Sure.

Interviewer: One last thing, they should have also let you know that we’re recording this. Do I
have your permission just so I can take your notes here?

Respondent: Yes.

Interviewer: Awesome so then, you know exactly what we’re here to do and how it’s going to
work. Do you have any questions before we start?

Respondent: No, I don’t think so.

Interviewer: Jump right in and let’s talk if you could by starting way back before you knew you
needed the knee surgery. What was going one? What were you experiencing? What
were you feeling?

Respondent: I had a knee injury years ago that just bothered me for about 12 years and I’ve
been getting cortisone injections for the pain and stiffness and the doctor had been
telling for about a year that my knee was just worn out and I was going have to
have a knee replacement. It just took a while for me to be able to do it.

Interviewer: When you first injured it 12 years prior, there was no repair or surgery done at that
time?

Respondent: No, it was a torn ACL but they opted not to repair it at the time so I didn’t have
any surgery to the knee at that time.

Interviewer: Were you seeing the doctor over the duration of the 12 years until that point where
you were told you’re going to need the surgery?

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Respondent: Not an orthopedic doctor, just my regular family doctor who did some X-rays and
referred me to an orthopedic doctor but I wasn’t seeing a doctor just for my knee.
It comes when it bothered me. I’d mentioned it to him.

Interviewer: If I understand you correctly, you injured it. You tore the ACL. Over the course of,
say, 11 years, your family doctor was watching it and eventually discovered that
things had gotten worse and - [Crosstalk]

Respondent: Exactly, he put in the X-ray and referred me to an orthopedic doctor.

Interviewer: Were there other issues and medical things going on during that time?

Respondent: Not really, just usual checkups and stuff. There really wasn’t anything else going
on.

Interviewer: It sounds like the family doctor - [Crosstalk] I’m sorry?

Respondent: Just trouble walking.

Interviewer: Okay, and you were discussing that with your regular doctor.

Respondent: Yes.

Interviewer: Talk to me if you could about the steps that took place once that doctor decided
you should go further in dealing with the knee. What were the steps toward
eventually receiving the surgery?

Respondent: Their office referred me. I had to find [Unintelligible] to the doctor that would
take my insurance and they referred me to an orthopedic doctor. It took me about
four weeks to get in. I went and I already had some X-rays. He ordered some more
X-rays. Anyway, I went in and he ordered some more X-rays. He wanted these X-
rays done before I saw him so I went in and had X-rays done that morning. I saw
him that afternoon and he told me that, at that point, we could do these injections
for the pain but I was looking at needing surgery and I guess I was scared at that
point and I needed to increase some PTO time at work to be able to take off that
long. I wasn’t prepared to take off work that long at that very moment so we went
with the cortisone injections to try to alleviate the pain and swelling and I just

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 didn’t get much of any relief from that. Anyway, I saw him again in about six
months and then, again, in about three months and I scheduled the surgery. It took
me almost a year from the time of seeing him for me to get into [Unintelligible]
before I was ready to have the surgery.

Interviewer: Did you see other orthopedic surgeons?

Respondent: No, I didn’t.

Interviewer: How come?

Respondent: Mostly, insurance restrictions, they say “Get a second opinion. Get a second
opinion.” It costs $400.00 or $500.00 to walk into an orthopedic doctor and your
insurance company isn’t going to pay for it twice. It’s hard enough for them to pay
for it once so you pretty much have to go and then, we see what’s recommended
by my family doctor I trusted and he was on my insurance and the limitation or I
quite possibly would have maybe seen another surgeon but the insurance limits you
from that option.

Interviewer: I see so as you met with this doctor a couple of times over the course of time you
were receiving the cortisone shots, what were you thinking about? What about that
doctor were you noticing or observing that might have played into your decision to
continue seeing that individual?

Respondent: I’m a big baby when it comes to pain and he seemed very sensitive and
acknowledged that he could tell by the X-rays that I was generally having a hard
time and having a lot of pain and, at that point, he seemed compassionate about it
and I didn’t feel pressured into having surgery. He told me, from the beginning, I
needed it but he also seemed to understand my reservations and the personal
things I had to get in before I could be off from work for that long.

Interviewer: Were you dealing over that time with other people in that doctor’s office?

Respondent: Yes, he has an assistant that helps with insurance issues and that sort of thing and
they helped me navigate the insurance process and figure out what my out of cost
expenses were going to be when I did have surgery.

Interviewer: Okay.

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Respondent: That’s really the only other person.

Interviewer: Where the surgery actually took place, were you able to get the shots in the
doctor’s office?

Respondent: Yes.

Interviewer: Then, you knew you were going to have surgery. Was that going to be in a hospital
or a surgery center?

Respondent: In a hospital.

Interviewer: Did the hospital play a role in your decision about using that surgeon for the
procedure?

Respondent: The hospital had a good reputation. My mother had used them back in the day and I
was comfortable. What little bit I know about hospitals, I was okay with the
hospital that he recommended.

Interviewer: Now, we’re at the point where you’ve committed to the surgery and it sounds like
you had quite a journey even before getting to the point where you knew you were
going to have it but now that you know that you have a surgery and you have a
date, let’s talk about how you prepared for it and what were you thinking about.
As you anticipated the actual procedure, what were the things that were on your
mind?

Respondent: I guess the biggest thing in my mind was how bad I was going to hurt, how could I
possibly get to walk and these are things they said I would be able to do after
having this piece of metal put in my knee and sawn back up. I just couldn’t imagine
how I would do that, how I would tend to the things around my home, how I would
tend to my parents and how I would possibly be able to get around and do the
things that I needed to do and how bad the pain was going to be.

Interviewer: Were you asking anyone about these questions or these thoughts?

Respondent: The pain part, I was. The rest of it is personal. It’s like everybody has those issues
where they had to make – I’m single so whatever gets done, I had to do and so
everybody has those issues in their personal lives if they had to line up for surgery

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 and I didn’t hear that with the doctor because none of that seemed like their issue
really.

Interviewer: Were there people in your life who have had this procedure that you might have
spoken to about it?

Respondent: No, I didn’t have anybody in my family or anybody that has had a knee
replacement.

Interviewer: If you did have access to somebody with that experience, might you have shared
some of those feelings and thoughts that you described?

Respondent: Yes, I look up some things online but it would have been nice to speak with
someone who had been through it and could tell me their personal feelings just
person to person about here’s what’s going to happen. Sometimes, the fear of the
unknown is worse than the reality or whatever and I just had a lot of anxiety.

Interviewer: What were the questions that you did ask or the information that you did receive?
How did you learn what you needed to know in order to prepare for the surgery?

Respondent: I asked the doctor and mostly his assistant what I needed to have at home, what I
needed to expect to have at home and he told me I would be using crutches and I
realized early on in physical therapy firsthand in the room that I don’t have the
upper body strength to use crutches. I could not possibly use crutches and I wish I
had known that beforehand. I could have had a walker already ordered and been
better prepared because I thought I was going to walk on crutches but the reality is
I’m just simply not strong enough to do it. It’s harder to do than it looks and I’m
not really sure. Anyway, the physical therapist came in and said “No, you’re not
going to be able to do crutches. You’re going to need to do a walker,” and that
threw me for a loop. I don’t know why it makes sense. At the end of the day, it
didn’t really matter. It was just a surprise.

Interviewer: Was that when you were still in the hospital?

Respondent: That was the day after surgery.

Interviewer: Let’s talk about this. The surgeon might have given you some information. The
assistant in the office might have given you some information. Some of it sounds

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 maybe like it didn’t turn out to be accurate in terms of what you would
experience. What were you talking about with the surgeon? What were you talking
about with the assistant? What were you talking about with anyone else or any
other resource to help get you ready for this?

Respondent: The surgeon, I was mostly talking about how long it was going to take for me to
recover and what kind of anesthesia I was going to have and what kind of pain
control I would have. The assistant talked to me a little bit about that I would have
physical therapy not just in the doctor’s office but that I would need to have
outpatient physical therapy after I left and seeing the insurance person. I don’t
know exactly what her job was but the one that helped me navigate the insurance
process.

Interviewer: Taking all of that together, on a scale of 1-10, how well-informed do you feel you
were on the day you started walking to the hospital for the procedure?

Respondent: Maybe about a five.

Interviewer: Five?

Respondent: Yes.

Interviewer: What might have made it more like a 10? Might that be different types of
information or people or – [Audio Gap]

Respondent: I went and pre-registered at the hospital when I was told that the anesthesiologist
would call me the night before surgery and nobody called me and that worried me.
I think I would have felt better if I had talked to the anesthesiologist the night
before because I had to come in really early the next morning and I was frightened
I wouldn’t be able to talk to him at all. I think that would have been better if I had
been better heard with the knowledge of what equipment I was going to need at
home. I ended up needing the walker and a potty [Unintelligible] that sits over my
commode to make it higher and we were struggling, once I got home, to get them.
I felt a lot of things I knew that I didn’t know or I wouldn’t have known if I hadn’t
looked up things online.

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Interviewer: Knowing what you know now, what kinds of things would you be asking any of these
informational resources before the surgery?

Respondent: I would want to know exactly what I need at home. Everybody’s different but I
would want a little more of a chronological event of week one to two which we
would expect you to be at this level. After two weeks, you should be able to walk
this far. Maybe, that’s unrealistic or whatever but some sort of expectation of
where I was going to be is clumsy and scared of falling, in pain and all that I was in.
it first made me feel like I had just made possibly a huge mistake and was not going
to be able to be this way forever. It seems silly now but I think if someone had just
told me it’s going to be a person to person basis, you’ll look into the second week
and you’re going to start feeling better or something like that, some sort of time
frame. [Once a day], thinking that I was never going to feel normal again.

Interviewer: Let me show you something. I do want to make sure before we move on that I
really understand your mindset. If you think about the time when you approached
the surgery and I’m getting a sense of how you might answer some of these but I’d
like you to think in terms of some language. You should see some arrows on the
screen, right? Are they there for you?

Respondent: Okay.

Interviewer: You don’t have to use numbers but if you look at these in terms of feeling relaxed
versus anxious, ready versus unprepared, knowledgeable versus confused and
capable versus uncertain whether you’re doing it right, where would you say, in
those days prior to the surgery, your thoughts were? More toward the green, more
toward the red, somewhere in the middle?

Respondent: More to the red.

Interviewer: All four of these?

Respondent: On all four of them.

Interviewer: I think we talked about this but just to some up, what specific source of
information would have moved you closer to the green in those days just before
your surgery?

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Respondent: I think if I have talked to the anesthesiologist and have had a better idea of how
they were going to control my pain and if I had known how difficult physical
therapy was going to be at first, that it was going to be easier. I would have felt
less anxious and confused and all. Let me think about the last one. I’m not sure I’m
doing this right.

Interviewer: Are these related? The more you know, the more capable you feel?

Respondent: I believe so.

Interviewer: I know you said you really didn’t have people in your life who had experienced this
procedure. Suppose the tables were turned and now, someone else was going to be
experiencing it. What would you want them to know based on your own
experience?

Respondent: I would want them to know how important it is to ask the doctor or the doctor’s
assistant every single question that you can think of no matter how ridiculous it
might be. I would want them to know just like my third physical therapy and
getting up that first day is really hard. I had to ask for pain medication to keep the
pain under control but be cooperative and, rest assured, it will get a little bit
better every day and I would also encourage them to be more prepared at home.

Interviewer: What home preparation is important for someone having this procedure?

Respondent: You need to look at how even your bedroom is set up. Do you need to move the bed
over and give yourself because, now, you’re not just getting in bed. You’ve got a
walker and that sort of thing and maybe, even a potty chair or something. Look
around your home and see if you need to spread some furniture and make a little
more room to get in and out of bed. Look at your bathroom and your shower
facilities. Are you going to be able to get over that? I have a walk-in shower
fortunately but if you didn’t, are you going to be able to get over that bathtub and
look at your bathroom and your bedroom and your living space and see if you need
to make some temporary accommodations for when you get home and now when
you get home and find out you should have done this at the best time.

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Interviewer: Was there anyone who prepared you for look where your bed is, take a loot at your
shower?

Respondent: No.

Interviewer: [Crosstalk] – that you discovered on your own?

Respondent: Those are things that just never occurred to me.

Interviewer: Who was involved in helping you while you recovered at home?

Respondent: My sister, I have a sister who lives in the same town I do and she came and brought
me home from the hospital and she stayed in the first couple of nights. She’s the
one that ended up rearranging my bedroom and making my bed easier for me to
get in and out of my bed and help me with my bathroom and help me order the
supplies and get the correct equipment that I needed for my home.

Interviewer: We’ll come back to that equipment but one question first. How well did you and/or
your sister understand what your need for assistance would be like with her
involved?

Respondent: I didn’t really know because I didn’t think need I was going to need her and then,
in the hospital, I realized that, yes indeed, I was going to need her at home. I
wasn’t going to be able to prepare meals and that sort of thing the first week of so.

Interviewer: That wasn’t something that you understood or arranged before you were in the
hospital?

Respondent: I had arranged it. I, maybe was in to know and she had said “I was going to help
you” because [Unintelligible] I was going to know about how much help I was going
to need. At the end, I did need her more than I thought I did.

Interviewer: Was there anyone advising you on it or was this just trial and error?

Respondent: It was trial and error. From the first day that she brought me home from the
hospital and had to rearrange my bedroom and all that, I knew that I was really
going to need for a few days.

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Interviewer: We talked about that I’d come back to supplies. Did your sister help you collect the
kinds of supplies you would need?

Respondent: Yes, the doctor wrote a prescription for a walker and a [Unintelligible] and all of
that and had it delivered to the hospital so I had that before I left but when I got
home I couldn’t. The way my bathroom was designed, I couldn’t get actually sit
down on the commode so my sister called the medical supply company and they
sent over a chair that goes over the commode and raises it up and it was a vast
favor because it was so much easier to get on and off of. She called the company
and told them what was going on and the problem I was having and that’s what
they recommended and they actually delivered it to me.

Interviewer: What did you have on hand or did you know that you would be needing and what
things did you discover on your own that you’d be in need of?

Respondent: I didn’t really have much of anything on [Unintelligible] because I just didn’t know
what I would need.

Interviewer: How should you have known? Should it have been different?

Respondent: Again, if they had told me to look around my house and make accommodations and
all, I would have had my house better prepared the way it needed to be when I
came home. I would have had the correct equipment.

Interviewer: What’s included in the correct equipment? The commode, the walker, what
[Crosstalk] with you?

Respondent: That’s really all they offered sitting home with the [CPM] machine. [Unintelligible]
CPM, continuous passive motion, [Unintelligible] in it and brings it up and down. I
didn’t know I was going to be going home with one of those. The physical therapy
sent me home with one of those. They did show my sister how to use it before we
left the hospital how it was supposed to be. Again, I didn’t know I was going to
need any of that and so that had to be factored into the whole setting of the
bedroom and all.

Interviewer: So that machine and the walker in the bathroom, were those all things that you
returned after having them?

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Respondent: Yes.

Interviewer: Who provided or paid for your use of them and how did you give them back?

Respondent: The CPM machine, I returned to the physical therapy department that I was using.
I’m sorry. I did not return the walker. I guess the insurance paid for it and I did not
return it. I still have it and then, the bed type commode thing was as rental and
when I didn’t need it anymore, they came and got it.

Interviewer: Where there supplies that you used it once? I don’t know if there were bandages or
smaller items that were helpful in your recovery.

Respondent: Not that I can think of. The one pair was really easy to use. It was just like cleaning
it with soap and water and there wasn’t really any need for bandages or anything.

Interviewer: Do you use a compression sleeve on your leg?

Respondent: I did in the hospital. I didn’t once I got home.

Interviewer: Were there items that might not have been medical in nature but made it easier to
be home? Maybe things that you used to help when you’re eating or sitting in a
certain chair, anything of that nature?

Respondent: Not that I can think of, you need a high chair and softer corners. It’s really a good
idea to use and sitting in a lot of softer corners. I found that it’s not easy to do.
You lean too far back and then, it makes it harder to get out of chair. I found
myself doing better just sitting on a hardback chair. I just can’t think of any other
small things that I wish would have had or whatever.

Interviewer: Maybe I’m missing, was there anything that you actually purchased to help you
recover from the surgery?

Respondent: No, the insurance paid for most everything. The walker and the rental and the
commode chair and I guess the CPM machine was rented or something. I’m not sure
but, no, I didn’t have to purchase. I don’t remember purchasing anything
substantial.

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Interviewer: Let’s pretend you might have received a list in advance that would have described
the items that would be helpful for you to have as you recover from surgery.
Maybe, you didn’t have something and you would have liked to have had it or
maybe something like a walker must be at the top of this list. What would be some
things that you would put on a list that should be checked off for someone who’s
going to have total knee replacement surgery?

Respondent: Walker, bathroom accommodation and prepare to have help for everyday things,
prepare your home for the extra equipment that’s going to be in there. Make sure
your bed is high enough off the ground which you can get on and off without too
much difficulty. I think with the crutches versus walker thing could have been
determined before surgery that I was not a candidate for walking on crutches.
Perhaps, that could have been done beforehand. They could have evaluated and
maybe see if I was even going to be able to walk on crutches because I couldn’t
walk on crutches without knee surgery.

Interviewer: Did your visual just go dark?

Respondent: I see me but I don’t see you.

Interviewer: Yes, my connection just jumped out. We’ll keep talking while I get back on and I’m
so sorry. It must be an internet situation. Let me type in my credentials and I’ll be
back in a second.

Respondent: Okay.

Interviewer: [Pause] While I’m returning, I want to float an idea by you. Suppose there was a kit
that you might have been able to have that would have included objects,
materials, supplies and things that would have been useful for you in recovery from
the knee surgery and also information. What might have you thought about the
availability of a kit like that?

Respondent: I think it would have been very helpful. A book or even a pamphlet about physical
therapy and the exercises you’re going to do so that it’s not all totally new to you
when they tell you to do certain things with your new and how to get in and out of
bed. I think if you had a little bit of familiarity with it beforehand, that would
help.

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Interviewer: Physical therapy, what other information should be in there?

Respondent: I think information on how best to utilize your insurance benefits, how the
equipment can be rented rather than purchased for people that it might be an
issue. Maybe, a list of resources and people, home help or something like that, of
people that you could hire to help if you didn’t have anybody or even a video or a
web hotlink that you can go to. They don’t have to teach everybody individually.
They could refer you to just a website or a link and site. Go to this and they’ll give
you a rundown, a review of what’s going to happen. Today is surgery and what you
can expect today. Something that I could read would be fine but, then again, a
website of some sort.

Interviewer: You’ve talked about information that was chronological, what to expect in week
one, what to expect in week two. Would that be something that belongs in a kit
like this?

Respondent: I think so. Just so you can prepare about where you’re going to be and how much
help you’re going to need, how long you’re going to need and how long you’re
going to need these accommodations.

Interviewer: What about items? The items that you’ve mentioned using, the walker, the
commode and the continuous motion, should those come with this kind of a kit?
Should other items come with a kit like this?

Respondent: I don’t know. That doesn’t sound real practical because I don’t know. Did
everybody use the CPM machine and not everybody may use the walker. Some
people may already have a walker. They may need different kinds of walkers. I
don’t know how practical that would be to have those items in there. I think those
seem a little more patient specific.

Interviewer: What about things that maybe you didn’t have that made you feel more
comfortable? Can you think of anything like that?

Respondent: You mean after surgery? No, I can’t think of anything other than somebody assuring
me that it was going to keep better.

Interviewer: So the information seems more of the useful piece here?

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Respondent: Right, had I had a little bit more insight into what to expect.

Interviewer: At what [Audio Gap] would you want to receive this kind of informational kit?

Respondent: Probably before or once I scheduled surgery.

Interviewer: In advance so how far in advance of the surgery itself?

Respondent: I would say several weeks.

Interviewer: This is something you’d pay for.

Respondent: Yes, I would pay depending on the cost. I’d pay for it. I don’t know though if I
would or not. The doctor makes a lot of money for the surgery so if they threw in a
little kit with some information, I don’t know that I’d really be that keen on paying
for it. Information is so readily available now. It’s just that I would have just liked
it more [Unintelligible] because you know how you can Google information and fall
into a rabbit hole.

Interviewer: Who do you think you would be getting this kit from?

Respondent: I would just think it would be from the doctor’s office.

Interviewer: From the doctor’s office?

Respondent: Yes.

Interviewer: Might it be something that the hospital itself would provide?

Respondent: Perhaps but you don’t really have much dealing with the hospital beforehand.

Interviewer: I see. What about a health insurance company?

Respondent: That would be good.

Interviewer: Explain how that would be good.

Respondent: You mean if they provided it?

Interviewer: Yes, who’s your insurance company?

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Respondent: Humana.

Interviewer: Okay, if this came from Humana, how would that make you feel?

Respondent: It’d make me feel like they were being generous and helping me along the way.

Interviewer: Would you be open to receiving it from a health insurance company that wasn’t
your own or that was someone other than Humana but went to the effort to
compile it?

Respondent: Yes.

Interviewer: If it were your insurance company does that affect the point in time at which you
might receive it?

Respondent: I would think so because they’re probably not going to send out the kit until your
insurance has been approved and all.

Interviewer: Would the doctor send it earlier? If you got it from the doctor’s office, would it
come to you earlier than if the insurance company was providing it?

Respondent: Possibly, the doctor makes sure that the insurance is going to pay for the surgery
before they schedule you too so I don’t know that necessarily the kit would come
beforehand and just because the doctor said he’s going to do surgery, they still
have to find out if they’re going to get paid.

Interviewer: I know I’m getting close to the time that we told you we’d let you go and I actually
have covered all of the formal questions that I have to ask but before I let you go,
I’d really want to understand, generally speaking, what you think should have
happened differently to make your experience with this surgery different in a more
positive way?

Respondent: I don’t mean to make it sound like it was all negative because, at the end of the
day, the surgery was successful. My knee feels a lot better. I’m doing real good so I
don’t mean to make it sound all negative but I think just more information about
the first week or two after surgery would have been the best help, what to expect
and how to prepare for it.

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Interviewer: Could you imagine that your experience would have been changed at all if you had
supplies that might have just been there to make you feel more comfortable? A
kind of pillow that you could sit with or a drinking cup with a lid, I’m just popping
ideas out. [Crosstalk]

Respondent: I think anytime that you go and do something like that and even if it is a pillow or a
mug that says “Good luck” or whatever, anytime a little thing like that does make
you feel like somebody cares or somebody gets that having your knee replaced isn’t
an everyday occurrence. It’s a big deal.

Interviewer: So if things like that were included in the kit along with information that you
described, how would that [Audio Gap] about whoever provided the kit to you?

Respondent: If they went the extra mile to make it nice and it wasn’t just information, there
was a little drinking mug or a keychain or something like that, just anything you
might need from the hospital, a little paper stand, a shampoo set, just anything
like that. Little things like that always make it nice.

Interviewer: I hear you. Jessica, thank you. You’ve really shared very important information
from personal experience which I appreciate greatly. I want to let you know we’re
going to be doing these interviews through the rest of this month actually so I don’t
know when they process the honoraria. It may come in August but [Unintelligible]
check back with us if you need to.

Respondent: Alright.

Interviewer: Thank you so much. Have a wonderful afternoon.

Respondent: You too, bye bye.

Interviewer: Bye bye. [Pause]

- End of Recording -

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Respondent:

Interviewer:

Respondent:

Interviewer:

- End of Recording -

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Page 18 of 18