Prospective evaluation of an informational web-based calculator
for communicating estimates of personalized treatment outcomes
To evaluate the usability, effectiveness in communicating benefits and risks, and impact on decision quality of a calculator
tool for patients with intervertebral disc herniations, spinal stenosis, and degenerative spondylolisthesis who are deciding between surgical and nonsurgical treatments.
Summary of Background Data.
The decision to have back surgery is preference-sensitive and warrants shared decision making. However, more patient-specific, individualized tools for presenting clinical evidence on treatment outcomes
Using Spine Patient Outcomes Research Trial data, prediction models were designed and integrated into a web-based calculator
. Consumer Reports subscribers with back-related pain were invited to use the calculator via
email, and patient participants were recruited to use the calculator
in a prospective manner following an initial appointment at participating spine centers. Participants completed questionnaires before and after using the calculator
. We randomly assigned previously validated questions that tested knowledge about the treatment options to be asked either before or after viewing the calculator
A total of 1256 consumer reports subscribers and 68 patient participants completed the calculator
and questionnaires. Knowledge scores were higher in the postcalculator group compared to the precalculator group, indicating that calculator
usage successfully informed users. Decisional conflict
was lower when measured following calculator
use, suggesting the calculator
was beneficial in the decision-making process. Participants generally found the tool helpful and easy to use.
Although the calculator
is not a comprehensive decision aid
, it does focus on communicating individualized risks and benefits for treatment options. Moreover, it appears to be helpful in achieving the goals of more traditional shared decision-making tools. It not only improved knowledge scores but also improved other aspects of decision quality.
Level of Evidence: 2