Effects of Patient Portal Message Framing on Treatment Preferences and Expectations for Degenerative Meniscus Tears: Randomized Exploratory Cross-Sectional Survey Study

Abstract

Background: Degenerative meniscus tears are common in middle-aged and older adults, and current guidelines favor nonoperative care. As patients increasingly turn to portal systems to view imaging results and communicate with their physicians, patient-facing wording may shape downstream treatment preferences and expectations.

Objective: This study aimed to determine whether subtle differences in physician message framing about an identical degenerative meniscus tear influence preferred management, expectations for improvement with conservative therapy, and satisfaction when a physician recommends a different plan.

Methods: A cross-sectional 37-question survey was developed de novo and distributed in January 2026 to lay adults in the United States (≥18 years) recruited via Amazon Mechanical Turk. Respondents were presented with a standardized vignette of an adult aged 60 years with knee pain due to a degenerative meniscus tear. Participants were randomized in a 1:1:1 fashion into 3 physician portal message framing groups: neutral, degenerative, and damage. Outcomes were the preferred next step in treatment, expected improvement with physical therapy, and retained satisfaction under physician-respondent disagreement. Chi-square and Fisher exact tests were used to compare categorical variables. Multivariable logistic regression analyses were used to assess associations between framing groups.

Results: Of the 266 completed responses, 195 (73.3%) were included for analysis (neutral: n=67, 34.4%; degenerative: n=63, 32.3%; damage: n=65, 33.3%). Treatment preferences differed significantly across groups (χ²₂=6.1; P=.047), and the damage group was significantly more likely to prefer aggressive interventions (odds ratio 2.43, 95% CI 1.17-5.06; P=.02). Expectations for physical therapy success differed significantly (χ²₄=12.3; P=.02), with the damage group being most pessimistic about conservative care. Retained satisfaction under physician-respondent disagreement did not differ by framing group (χ²₆=6.7; P=.35) but did differ significantly by initial treatment preference (P=.03) and was the lowest among respondents preferring steroid injection.

Conclusions: In this exploratory investigation, subtle differences in physician portal message framing regarding a magnetic resonance imaging impression of a degenerative meniscus tear were associated with shifts in treatment preferences and confidence in conservative care. These findings suggest that brief physician portal communications may be associated with shifts in hypothetical patient expectations and treatment preferences before clinical counseling occurs.

Keywords: arthroscopy; communication; decision-making; health literacy; knee injuries; meniscus; patient portals; shared.