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BMC Med Inform Decis Mak. 2019 Oct 4;19(1):190. doi: 10.1186/s12911-019-0906-9.

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

Author information

1
Spine Surgery and Research, Spine Center of Southern Denmark, Lillebaelt Hospital - University Hospital of Southern Denmark, Øster Hougvej 55, Middelfart, Denmark. stina.brogard.andersen@rsyd.dk.
2
Center for Shared Decision Making, Lillebaelt Hospital - University Hospital of Southern Denmark, Vejle, Denmark. stina.brogard.andersen@rsyd.dk.
3
Faculty of Health Sciences, Institute of Regional Health Research, University of Southern Denmark, Odense, Denmark. stina.brogard.andersen@rsyd.dk.
4
Spine Surgery and Research, Spine Center of Southern Denmark, Lillebaelt Hospital - University Hospital of Southern Denmark, Øster Hougvej 55, Middelfart, Denmark.
5
Faculty of Health Sciences, Institute of Regional Health Research, University of Southern Denmark, Odense, Denmark.
6
Norton Leatherman Spine Center, Louisville, KY, USA.
7
Center for Shared Decision Making, Lillebaelt Hospital - University Hospital of Southern Denmark, Vejle, Denmark.
8
Nuffield Department of Population Health, University of Oxford, Oxford, UK.
9
Department of Clinical Oncology, Lillebaelt Hospital - University Hospital of Southern Denmark, Vejle, Denmark.

Abstract

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. 1) Assessment of the extent to which SDM was practiced in the spine clinic. 2) Development of a PtDA to support SDM. 3) Testing its usability and acceptability amongst potential users (patients). 4) 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.

KEYWORDS:

Lumbar disc herniation; Patient decision aid; Shared decision making; Spine surgery

PMID:
31585534
PMCID:
PMC6778367
DOI:
10.1186/s12911-019-0906-9
[Indexed for MEDLINE]
Free PMC Article

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