Hwang Richard, Lambrechts Sylvia, Liu Hui, Saigal Christopher S, Kwan Lorna, Cisneros Crystal, Holly Langston T, Duru O Kenrik
David Geffen School of Medicine at UCLA, Los Angeles, California, USA.
Department of Urology, David Geffen School of Medicine at UCLA, Los Angeles, California, USA.
World Neurosurg. 2018 Aug;116:e680-e690. doi: 10.1016/j.wneu.2018.05.068. Epub 2018 May 18.
Lumbar herniated disc is a "preference-sensitive" condition, in which the optimal treatment choice is crucially dependent on an informed patient's goals and values. Little is known about decisional conflict, defined as an individual's level of uncertainty regarding a decision, in patients considering treatment for lumbar herniated discs. Our work aims to identify factors associated with decisional conflict and areas for improved shared decision making.
We prospectively surveyed patients seeking treatment for a lumbar herniated disc at L4-L5 and/or L5-S1 with a physician at the UCLA Spine Center. Decisional conflict was measured using the validated SURE questionnaire. We performed univariate and multivariate logistic analysis to identify predictors of decisional conflict.
Among the 174 participants surveyed, 47% reported experiencing decisional conflict and 44% changed their treatment preference after the visit, with 61% of these opting for more invasive treatment. Participants with decisional conflict were less satisfied with their treatment decision (P < 0.001) and less willing to recommend their physician (P = 0.003) and physician's medical group to others (P = 0.003). Multivariate analysis revealed that participants were more likely to experience decisional conflict if they consulted with a physiatrist compared with a surgeon (odds ratio [OR], 2.6; P = 0.019) and if they did not feel able to discuss the various treatment options with the doctor during the visit (OR, 8.5; P < 0.001).
Many patients with a lumbar herniated disc experience decisional conflict when choosing a treatment option. Our results highlight the need to implement tools and strategies to improve decisional quality, such as decision aids before consultation.
腰椎间盘突出症是一种“偏好敏感”疾病，其中最佳治疗选择关键取决于患者明智的目标和价值观。对于考虑腰椎间盘突出症治疗的患者，关于决策冲突（定义为个人对决策的不确定程度）知之甚少。我们的研究旨在确定与决策冲突相关的因素以及改善共同决策的领域。
我们前瞻性地调查了在加州大学洛杉矶分校脊柱中心寻求治疗L4 - L5和/或L5 - S1腰椎间盘突出症的患者。使用经过验证的SURE问卷测量决策冲突。我们进行了单变量和多变量逻辑分析以确定决策冲突的预测因素。
在接受调查的174名参与者中，47%报告经历了决策冲突，44%在就诊后改变了他们的治疗偏好，其中61%选择了更具侵入性的治疗。有决策冲突的参与者对其治疗决策的满意度较低（P < 0.001），不太愿意向他人推荐他们的医生（P = 0.003）和医生的医疗团队（P = 0.003）。多变量分析显示，与外科医生相比，如果参与者咨询的是康复科医生（优势比[OR]，2.6；P = 0.019），以及如果他们在就诊期间感觉无法与医生讨论各种治疗选择（OR，8.5；P < 0.001），则他们更有可能经历决策冲突。
许多腰椎间盘突出症患者在选择治疗方案时会经历决策冲突。我们的结果强调需要实施工具和策略来提高决策质量，例如在咨询前提供决策辅助工具。
