New patient survey shows improved quality of decisions about herniated disc surgery

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.

Patients whose choice of treatment matched their goals were less likely to say they regretted their treatment decision: 13 versus 39 percent. "Patients who matched were more likely to want to do the same thing again, indicating that they experienced less regret," Dr Sepucha and coauthors write.

There is a growing emphasis on "shared decision making" between patients and doctors—encouraging patients to play a more active role in deciding between treatment options for common medical conditions. For herniated discs, both surgical and nonsurgical treatments have advantages and disadvantages. While surgery provides may provide faster relief with less need for medications, nonsurgical treatment avoids the possible complications of surgery.

The new study shows that the HD-DQI is a useful tool for evaluating the quality of medical decision-making by patients with herniated discs. It also shows that a simple decision aid (such as watching a video) can improve patients' knowledge regarding their condition.

"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," according to Dr Sepucha and colleagues. Pending further research, they believe that surveys like the HD-DQI could help in meeting goals for "meaningful use" of electronic health information and new priorities for informed consent under health care reform.