The Trust-Behavior Paradox in Orthopedic Care: A National Survey of Care-Seeking, Misinformation, and Non-Physician Information Sources.

Abstract

Background: Trust in physicians remains a cornerstone of effective healthcare delivery; however, the rapid expansion of online and non-physician health information sources has introduced new challenges to patient decision-making. In orthopedic practice, delayed evaluation of musculoskeletal symptoms-particularly those concerning for malignancy-may be influenced by misinformation and alternative care pathways.

Methods: We conducted a cross-sectional, nationally weighted survey of U.S. adults (n=200) to evaluate care-seeking behavior, trust in information sources, and endorsement of cancer-related misconceptions. The survey assessed willingness to delay care for persistent bone or back pain, reliance on physician versus non-physician information sources, and responses to conflicting health information. Stratified analyses were performed based on chronic pain status and prior cancer-related experience.

Results: Although 85% of respondents identified physicians as their most trusted source of health information, 55% reported regular use of online or social media platforms. A substantial proportion of participants reported willingness to delay care for ≥3 weeks or until symptom progression. Individuals with chronic pain demonstrated significantly higher odds of delayed care-seeking (p<0.05) and misinformation endorsement (OR 1.5-2.5, p<0.05). Reliance on online information was independently associated with delayed medical evaluation (OR ~2.0, p<0.01). Notably, a subset of respondents reported prioritizing online information over physician recommendations when conflicts arose, representing the highest-risk group for delayed care.

Conclusion: A pronounced trust-behavior paradox exists in orthopedic care, wherein high trust in physicians does not consistently translate into timely care-seeking. Misinformation and reliance on non-physician information sources contribute to diagnostic delay, particularly among individuals with chronic pain or prior cancer-related experience. Targeted patient education and engagement in digital information spaces are critical to mitigating these risks.