Decisional Conflict Among Patients Considering Treatment Options for Lumbar Herniated Disc.
World Neurosurg
; 116: e680-e690, 2018 Aug.
Article
em En
| MEDLINE
| ID: mdl-29783012
ABSTRACT
BACKGROUND:
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.METHODS:
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.RESULTS:
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).CONCLUSIONS:
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.Palavras-chave
Texto completo:
1
Coleções:
01-internacional
Base de dados:
MEDLINE
Assunto principal:
Médicos
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Conflito Psicológico
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Tomada de Decisões
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Degeneração do Disco Intervertebral
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Deslocamento do Disco Intervertebral
Tipo de estudo:
Etiology_studies
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Observational_studies
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Prognostic_studies
/
Qualitative_research
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Risk_factors_studies
Limite:
Adult
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Aged
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Female
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Humans
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Male
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Middle aged
Idioma:
En
Revista:
World Neurosurg
Ano de publicação:
2018
Tipo de documento:
Article