Factors Affecting Patient Decision-making on Surgery for Lumbar Disc Herniation

Research output: Contribution to journalJournal articleResearchpeer-review

Abstract

STUDY DESIGN: Qualitative research using semistructured interviews.

OBJECTIVE: To explore, from a patient perspective, factors influencing a patient's decision-making process and the decision to have surgery for lumbar disc herniation.

SUMMARY OF BACKGROUND DATA: Since strong evidence favoring surgical over nonsurgical treatment is lacking and firm guidelines regarding the optimal timing of surgery are not available, it is essential to involve patients in the decision-making process. Thus the elements that might affect the decision-making process and the decision to have surgery must be identified.

METHODS: Using a hermeneutic-phenomenological approach, 14 patients who were referred for primary surgery for lumbar disc herniation were interviewed. Interviews were transcribed and analyzed using a meaning-condensation method to identify themes influencing a patient's decision-making process and the decision to have surgery for lumbar disc herniation.

RESULTS: Four main themes that could directly or indirectly influence the patients' decision-making process were identified: A) Patient information: patients' conceptions about treatment were not always based on sufficient information; B) Accelerated workflows: some patients needed time to process the information given, which may be limited due to accelerated workflows; C) Power imbalance: patients can be reluctant to challenge the system, as they do not want to offend, which can be seen as a power imbalance between clinicians and patients; and D) Personal past experience: experience, about treatment options from, i.e., close relatives, can impact patients thoughts about possible treatments.

CONCLUSION: Several factors can influence patients' decision-making process and the decision itself: the amount and quality of information received as compared with their preconceived notions, the amount of time given to consider their decision, reluctance to challenge the system and offend the healthcare provider, and past personal experience. Understanding these complex factors will help clinicians to better support patients choosing between surgical and nonsurgical treatment for lumbar herniated disc.

LEVEL OF EVIDENCE: 5.

Original languageEnglish
JournalSpine
Volume44
Issue number2
Pages (from-to)143-149
ISSN0362-2436
DOIs
Publication statusPublished - 15. Jan 2019

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Workflow
Interviews
Intervertebral Disc Displacement
Qualitative Research
Health Personnel
Guidelines
Power (Psychology)
Hermeneutics

Keywords

  • autonomy
  • decision-making
  • discectomy
  • herniated disc
  • lumbar disc herniation
  • patient perspective
  • qualitative research
  • shared decision-making
  • spine surgery
  • surgery
  • Decision Making
  • Intervertebral Disc Displacement/surgery
  • Humans
  • Middle Aged
  • Patient Participation
  • Male
  • Health Knowledge, Attitudes, Practice
  • Power (Psychology)
  • Time Factors
  • Adult
  • Female
  • Aged
  • Lumbar Vertebrae
  • Qualitative Research

Cite this

@article{c2616b2e66584154971596cfa23ca15a,
title = "Factors Affecting Patient Decision-making on Surgery for Lumbar Disc Herniation",
abstract = "STUDY DESIGN: Qualitative research using semistructured interviews.OBJECTIVE: To explore, from a patient perspective, factors influencing a patient's decision-making process and the decision to have surgery for lumbar disc herniation.SUMMARY OF BACKGROUND DATA: Since strong evidence favoring surgical over nonsurgical treatment is lacking and firm guidelines regarding the optimal timing of surgery are not available, it is essential to involve patients in the decision-making process. Thus the elements that might affect the decision-making process and the decision to have surgery must be identified.METHODS: Using a hermeneutic-phenomenological approach, 14 patients who were referred for primary surgery for lumbar disc herniation were interviewed. Interviews were transcribed and analyzed using a meaning-condensation method to identify themes influencing a patient's decision-making process and the decision to have surgery for lumbar disc herniation.RESULTS: Four main themes that could directly or indirectly influence the patients' decision-making process were identified: A) Patient information: patients' conceptions about treatment were not always based on sufficient information; B) Accelerated workflows: some patients needed time to process the information given, which may be limited due to accelerated workflows; C) Power imbalance: patients can be reluctant to challenge the system, as they do not want to offend, which can be seen as a power imbalance between clinicians and patients; and D) Personal past experience: experience, about treatment options from, i.e., close relatives, can impact patients thoughts about possible treatments.CONCLUSION: Several factors can influence patients' decision-making process and the decision itself: the amount and quality of information received as compared with their preconceived notions, the amount of time given to consider their decision, reluctance to challenge the system and offend the healthcare provider, and past personal experience. Understanding these complex factors will help clinicians to better support patients choosing between surgical and nonsurgical treatment for lumbar herniated disc.LEVEL OF EVIDENCE: 5.",
keywords = "autonomy, decision-making, discectomy, herniated disc, lumbar disc herniation, patient perspective, qualitative research, shared decision-making, spine surgery, surgery, Decision Making, Intervertebral Disc Displacement/surgery, Humans, Middle Aged, Patient Participation, Male, Health Knowledge, Attitudes, Practice, Power (Psychology), Time Factors, Adult, Female, Aged, Lumbar Vertebrae, Qualitative Research",
author = "Andersen, {Stina Brog{\aa}rd} and Regner Birkelund and Andersen, {Mikkel {\O}} and Carreon, {Leah Y} and Angela Coulter and Steffensen, {Karina Dahl}",
year = "2019",
month = "1",
day = "15",
doi = "10.1097/BRS.0000000000002763",
language = "English",
volume = "44",
pages = "143--149",
journal = "Spine",
issn = "0362-2436",
publisher = "Lippincott Williams & Wilkins",
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}

Factors Affecting Patient Decision-making on Surgery for Lumbar Disc Herniation. / Andersen, Stina Brogård; Birkelund, Regner; Andersen, Mikkel Ø; Carreon, Leah Y; Coulter, Angela; Steffensen, Karina Dahl.

In: Spine, Vol. 44, No. 2, 15.01.2019, p. 143-149.

Research output: Contribution to journalJournal articleResearchpeer-review

TY - JOUR

T1 - Factors Affecting Patient Decision-making on Surgery for Lumbar Disc Herniation

AU - Andersen, Stina Brogård

AU - Birkelund, Regner

AU - Andersen, Mikkel Ø

AU - Carreon, Leah Y

AU - Coulter, Angela

AU - Steffensen, Karina Dahl

PY - 2019/1/15

Y1 - 2019/1/15

N2 - STUDY DESIGN: Qualitative research using semistructured interviews.OBJECTIVE: To explore, from a patient perspective, factors influencing a patient's decision-making process and the decision to have surgery for lumbar disc herniation.SUMMARY OF BACKGROUND DATA: Since strong evidence favoring surgical over nonsurgical treatment is lacking and firm guidelines regarding the optimal timing of surgery are not available, it is essential to involve patients in the decision-making process. Thus the elements that might affect the decision-making process and the decision to have surgery must be identified.METHODS: Using a hermeneutic-phenomenological approach, 14 patients who were referred for primary surgery for lumbar disc herniation were interviewed. Interviews were transcribed and analyzed using a meaning-condensation method to identify themes influencing a patient's decision-making process and the decision to have surgery for lumbar disc herniation.RESULTS: Four main themes that could directly or indirectly influence the patients' decision-making process were identified: A) Patient information: patients' conceptions about treatment were not always based on sufficient information; B) Accelerated workflows: some patients needed time to process the information given, which may be limited due to accelerated workflows; C) Power imbalance: patients can be reluctant to challenge the system, as they do not want to offend, which can be seen as a power imbalance between clinicians and patients; and D) Personal past experience: experience, about treatment options from, i.e., close relatives, can impact patients thoughts about possible treatments.CONCLUSION: Several factors can influence patients' decision-making process and the decision itself: the amount and quality of information received as compared with their preconceived notions, the amount of time given to consider their decision, reluctance to challenge the system and offend the healthcare provider, and past personal experience. Understanding these complex factors will help clinicians to better support patients choosing between surgical and nonsurgical treatment for lumbar herniated disc.LEVEL OF EVIDENCE: 5.

AB - STUDY DESIGN: Qualitative research using semistructured interviews.OBJECTIVE: To explore, from a patient perspective, factors influencing a patient's decision-making process and the decision to have surgery for lumbar disc herniation.SUMMARY OF BACKGROUND DATA: Since strong evidence favoring surgical over nonsurgical treatment is lacking and firm guidelines regarding the optimal timing of surgery are not available, it is essential to involve patients in the decision-making process. Thus the elements that might affect the decision-making process and the decision to have surgery must be identified.METHODS: Using a hermeneutic-phenomenological approach, 14 patients who were referred for primary surgery for lumbar disc herniation were interviewed. Interviews were transcribed and analyzed using a meaning-condensation method to identify themes influencing a patient's decision-making process and the decision to have surgery for lumbar disc herniation.RESULTS: Four main themes that could directly or indirectly influence the patients' decision-making process were identified: A) Patient information: patients' conceptions about treatment were not always based on sufficient information; B) Accelerated workflows: some patients needed time to process the information given, which may be limited due to accelerated workflows; C) Power imbalance: patients can be reluctant to challenge the system, as they do not want to offend, which can be seen as a power imbalance between clinicians and patients; and D) Personal past experience: experience, about treatment options from, i.e., close relatives, can impact patients thoughts about possible treatments.CONCLUSION: Several factors can influence patients' decision-making process and the decision itself: the amount and quality of information received as compared with their preconceived notions, the amount of time given to consider their decision, reluctance to challenge the system and offend the healthcare provider, and past personal experience. Understanding these complex factors will help clinicians to better support patients choosing between surgical and nonsurgical treatment for lumbar herniated disc.LEVEL OF EVIDENCE: 5.

KW - autonomy

KW - decision-making

KW - discectomy

KW - herniated disc

KW - lumbar disc herniation

KW - patient perspective

KW - qualitative research

KW - shared decision-making

KW - spine surgery

KW - surgery

KW - Decision Making

KW - Intervertebral Disc Displacement/surgery

KW - Humans

KW - Middle Aged

KW - Patient Participation

KW - Male

KW - Health Knowledge, Attitudes, Practice

KW - Power (Psychology)

KW - Time Factors

KW - Adult

KW - Female

KW - Aged

KW - Lumbar Vertebrae

KW - Qualitative Research

U2 - 10.1097/BRS.0000000000002763

DO - 10.1097/BRS.0000000000002763

M3 - Journal article

VL - 44

SP - 143

EP - 149

JO - Spine

JF - Spine

SN - 0362-2436

IS - 2

ER -