Journal Article

Shared decision making when patients consider surgery for lumbar herniated disc: development and test of a patient decision aid

Steffensen, Karina Dahl, Andersen, Mikkel Ø., Coulter, Angela, Andersen, Stina Brogård, Carreon, Leah Y.

2019

Overview

Background Shared decision making (SDM) is a systematic approach aimed at improving patient involvement in preference-sensitive health care decisions. Choosing between surgical or non-surgical treatment for lumbar disc herniation, can be difficult as the evidence of a superior treatment is unclear, which makes it a preference-sensitive decision. The objectives of this study was therefore to assess the degree of SDM and afterwards to develop and test a patient decision aid (PtDA) to support SDM during the clinical encounter between surgeon and patient, when patients choose between surgical and non-surgical treatment for Lumbar disc herniation (LDH). Methods The study was conducted in four steps. Assessment of the extent to which SDM was practiced in the spine clinic. Development of a PtDA to support SDM. Testing its usability and acceptability amongst potential users (patients). Pilot-test of its usability in the clinical setting. Results Results from our small baseline study ( n  = 40) showed that between a third and two-thirds of the patients reported not being fully engaged in a shared decision. A pre-designed template ( BESLUTNINGSHJÆLPER ™) was adapted to support the decision about whether or not to have surgery for LDH. Testing the prototype with patients led to minor refinements. A subsequent pilot test of its usability in a clinical setting achieved positive responses from both patients and clinicians. Conclusion Our baseline study demonstrated that SDM was not universally practiced in the clinic. The PtDA we have developed was rated as acceptable and usable by both patients and clinicians for helping those with LDH choose between surgical or non- surgical treatment. This tool now requires further testing to assess its effectiveness.

• Publisher: BioMed Central,BioMed Central Ltd,Springer Nature B.V,BMC
• Subject: Acceptability / Adult / Analysis / Baseline studies / Care and treatment / Clinical decision-making / Collaboration / Decision Making / Decision Making, Shared / Design / Female / Health care reform / Health Informatics / Humans / Information Systems and Communication Service / Intervertebral Disc Displacement - surgery / Intervertebral discs / Intervertebral disk displacement / knowledge support systems / Lumbar disc herniation / Lumbar Vertebrae / Male / Management of Computing and Information Systems / Medical research / Medicine / Medicine & Public Health / Middle Aged / Navigation charts / Orthopedics / Pain / Patient decision aid / Patient Participation / Patient Selection / Patients / Physicians / Preferences / Prototype tests / Questionnaires / Research Article / Shared decision making / Spine / Spine (lumbar) / Spine surgery / Surgeons / Surgery / Surgical instruments / theory / Usability