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Related Experiment Videos

Treatment decisions about lumbar herniated disk in a shared decision-making program.

Paul H Barrett1, Arne Beck, Kristie Schmid

  • 1Clinical Research Unit, Kaiser Permanente of Colorado, 10350 E Dakota Ave, Denver, CO 80231-1314, USA. paul.h.barrett@kp.org

The Joint Commission Journal on Quality Improvement
|June 11, 2002
PubMed
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A video program increased patient preference for laminectomy surgery for lumbar herniated discs. Patient values strongly predicted treatment choice, supporting shared decision-making in surgical procedures.

Area of Science:

  • Neurosurgery
  • Health Services Research
  • Patient Decision Making

Background:

  • Shared decision-making is recommended for discretionary surgeries with high unexplained variation.
  • Laminectomy for lumbar herniated disc (HD) is an example of such a procedure.
  • An observational study evaluated a HD videodisk program's impact on patient outcomes.

Purpose of the Study:

  • To assess the effect of an educational videodisk on patient preferences for laminectomy.
  • To evaluate the impact on patient satisfaction and decision-making processes.
  • To understand treatment preferences in patients with lumbar herniated discs.

Main Methods:

  • Observational study enrolling Kaiser Permanente patients with lumbar HD indicated for surgery (May 1993-Dec 1995).

Related Experiment Videos

  • Patients viewed an HD videodisk program.
  • Follow-up surveys assessed treatment preferences and satisfaction (completed by Jan 1997).

    • Main Results:

    • Patient preference for laminectomy increased significantly, from 26.7% to 35.8%.
    • This shift was driven by decreased undecided patients and those preferring non-surgical treatment.
    • Post-viewing preference (74.0%) better predicted ultimate treatment choice than pre-viewing preference (70.0%).

    Conclusions:

    • Viewing the videodisk increased preference for laminectomy.
    • Patient's valuation of their condition was the strongest predictor of choosing surgery, supporting shared decision-making.
    • Low participation in videodisk programs suggests physicians should encourage pre-visit viewing.