A new patient survey can show improvements in the quality of patient decision-making about whether or not to undergo surgery for a herniated disc, reports a study in the August 15 issue of Spine. The journal is published by Lippincott Williams & Wilkins, a part of Wolters Kluwer Health.
Karen Sepucha, PhD, and colleagues of Massachusetts General Hospital, Boston, developed and evaluated a tool for use in evaluating the quality of patient decisions regarding treatment for herniated discs in the lower (lumbar) spine. The survey may help to promote shared decision-making, thus helping to ensure that "the right patient is matched with the right treatment."
Survey Shows Improved Quality of Decisions
The researchers developed a new "herniated disc decision quality instrument" (HD-DQI) to evaluate the quality of patient decisions regarding treatment for this common cause of back pain. The survey focused on two key factors affecting the quality of medical decisions: how much patients know about their condition and how well their chosen treatment matches their goals.
The HD-DQI was then used to evaluate decision quality for two groups of patients with herniated spinal discs. One group of patients had received a DVD and pamphlet, designed as a decision aid for herniated disc treatment. The other group did not receive the decision aid.
Based on the HD-DQI, patients who received the decision aid made better-quality decisions. Knowledge scores were 55 percent for patients who viewed the received the decision aid versus 38 percent for those who did not. Patients in the decision aid group knew more about the expected benefits of surgery as well as the risk of short-term complications after surgery.
Most patients in both groups chose a treatment that matched their goals—78 percent overall. When there was a mismatch, it was usually because the patient chose surgery when nonsurgical treatment would have been a better match. The desire to avoid surgery was the most important factor associated with choosing nonsurgical treatment, while not wanting to take medications for a long time was the main factor associated with chosing surgery.