Spine Surgery and Research, Spine Center of Southern Denmark, Lillebaelt Hospital, Middelfart, Denmark.
Center for Shared Decision Making, Lillebaelt Hospital, Vejle, Denmark.
Spine (Phila Pa 1976). 2019 Jan 15;44(2):143-149. doi: 10.1097/BRS.0000000000002763.
Qualitative research using semistructured interviews.
To explore, from a patient perspective, factors influencing a patient's decision-making process and the decision to have surgery for lumbar disc herniation.
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.
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.
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.
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.
采用半结构化访谈的定性研究。
从患者角度探讨影响腰椎间盘突出症患者决策过程和手术决策的因素。
由于缺乏支持手术优于非手术治疗的有力证据，也没有关于手术最佳时机的明确指南，因此必须让患者参与决策过程。因此，必须确定可能影响决策过程和手术决策的因素。
采用解释学-现象学方法，对 14 名因腰椎间盘突出症初次手术而转诊的患者进行访谈。访谈记录进行转录，并采用意义浓缩法进行分析，以确定影响腰椎间盘突出症患者决策过程和手术决策的主题。
确定了四个可能直接或间接影响患者决策过程的主要主题：A）患者信息：患者的治疗观念并非总是基于充分的信息；B）加速工作流程：由于工作流程加速，一些患者需要时间来处理所提供的信息；C）权力失衡：患者可能不愿意挑战系统，因为他们不想冒犯，这可以被视为临床医生和患者之间的权力失衡；D）个人过去的经验：来自亲密亲属等的治疗方案的经验可能会影响患者对可能治疗方法的想法。
几个因素可以影响患者的决策过程和决策本身：与先入为主的观念相比，患者收到的信息量和质量、考虑决策的时间量、不愿意挑战系统和冒犯医疗服务提供者，以及个人过去的经验。了解这些复杂的因素将有助于临床医生更好地支持患者在手术和非手术治疗腰椎间盘突出症之间做出选择。
5 级。
