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Patient decision-making survey improves treatment choices for lumbar spine surgery

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Researchers from Boston have developed a survey to measure patient decision-making for treatment of herniated discs in the lumbar spine.

“Given the increasing importance of engaging patients and families in significant medical decisions, there is a need for measures to assess the extent to which this is accomplished,” Karen R. Sepucha, PhD, and colleagues stated in their study.

The researchers developed a herniated disc decision quality instrument (HD-DQI) to evaluate the quality of patient decisions regarding treatment. The survey evaluates patient knowledge of their condition as well as how closely their treatment plan aligns with their own goals. Each factor is measured on a 0 to 100 scale and was developed with input from patients, survey research experts and clinical experts, according to the abstract.

Sepucha and colleagues split patients into two groups: one group received a DVD and a pamphlet designed to guide their decision, while the other group received no decision aids. When they used the HD-DQI, researchers found that patients with the decision aid scored a 55% in the knowledge category, while patients without the decision aid scored 38%. Treatment matched patient goals in 78% of cases in both groups. Discrepancies between treatment and personal goals most often occurred when patients chose surgery in cases where surgical intervention was not needed.

In patients who chose non-surgical treatment, the most common reason was because they did not want to have surgery, while patients who chose surgery noted that not wanting to take medication long term was the most important factor in their decision. Patients whose treatment matched their goal were less likely to regret their choice compared to patients who did not choose a goal-oriented treatment, according to the abstract.

Reference:

Sepucha KR, Feibelmann S, Abdu WA, et al. Psychometric evaluation of a decision quality instrument for treatment of lumbar herniated disc. Spine. 2012; 37(18):1609-1616. doi:10.1097/BRS.0b013e3182532924.