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Effects of Viewing an Evidence-Based Video Decision Aid on Patients' Treatment Preferences for Spine Surgery

Lurie, Jon D. MD, MS; Spratt, Kevin F. PhD; Blood, Emily A. MS; Tosteson, Tor D. ScD; Tosteson, Anna N. A. ScD; Weinstein, James N. DO, MS

doi: 10.1097/BRS.0b013e3182055c1e
Health Services Research

Study Design. Secondary analysis within a large clinical trial.

Objective. To evaluate the changes in treatment preference before and after watching a video decision aid as part of an informed consent process.

Summary of Background Data. A randomized trial with a similar decision aid in herniated disc patients had shown decreased rate of surgery in the video group, but the effect of the video on expressed preferences is not known.

Methods. Subjects enrolling in the Spine Patient Outcomes Research Trial (SPORT) with intervertebral disc herniation, spinal stenosis, or degenerative spondylolisthesis at 13 multidisciplinary spine centers across the United States were given an evidence-based videotape decision aid viewed prior to enrollment as part of informed consent.

Results. Of the 2505 patients, 86% (n = 2151) watched the video and 14% (n = 354) did not. Watchers shifted their preference more often than nonwatchers (37.9% vs. 20.8%, P < 0.0001) and more often demonstrated a strengthened preference (26.2% vs. 11.1%, P < 0.0001). Among the 806 patients whose preference shifted after watching the video, 55% shifted toward surgery (P = 0.003). Among the 617 who started with no preference, after the video 27% preferred nonoperative care, 22% preferred surgery, and 51% remained uncertain.

Conclusion. After watching the evidence-based patient decision aid (video) used in SPORT, patients with specific lumbar spine disorders formed and/or strengthened their treatment preferences in a balanced way that did not appear biased toward or away from surgery.

Patients in the SPORT trial were given an evidence-based video decision aid as part of their informed consent process. Comparing the patients' expressed treatment preference before and after watching the video revealed that patients who were uncertain at baseline were often able to form a preference after the video and those patients who started with an initial preference tended to strengthen that preference. There was no consistent trend in preference shifts either toward or away from surgery, suggesting that the decision aid had a balanced effect on treatment preferences.

From the Dartmouth Medical School, Hanover, NH.

Address correspondence and reprint requests to Jon D. Lurie, MD, MS, Department of Internal Medicine, Dartmouth-Hitchcock Medical Center, One Medical Center Dr., Lebanon, NH 03756; E-mail:

Acknowledgment date: August 3, 2009. Revision date: July 20, 2010. Acceptance date: July 21, 2010.

The manuscript submitted does not contain information about medical device(s)/drug(s).

Federal funds were received in support of this work. No benefits in any form have been or will be received from a commercial party related directly or indirectly to the subject of this manuscript.

Supported by The National Institute of Arthritis and Musculoskeletal and Skin Diseases (U01-AR45444) and the Office of Research on Women's Health, the National Institutes of Health, and the National Institute of Occupational Safety and Health, and the Centers for Disease Control and Prevention.

This paper was presented as a poster at the International Society for Study of the Lumbar Spine annual meeting in Hong Kong, May 2007.

© 2011 Lippincott Williams & Wilkins, Inc.