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Factors Affecting Patient Decision-making on Surgery for Lumbar Disc Herniation

Andersen, Stina Brogård, MHS∗,†,‡; Birkelund, Regner, Dr. Phil.‡,§; Andersen, Mikkel Ø., MD∗,‡; Carreon, Leah Y., MD, MSc∗,‡; Coulter, Angela, MSc, PhD, Hon FFPH, Hon FRCGP†,‡; Steffensen, Karina Dahl, MD, PhD†,‡

doi: 10.1097/BRS.0000000000002763

Study Design. Qualitative research using semistructured interviews.

Objective. To explore, from a patient perspective, factors influencing a patient's decision-making process and the decision to have surgery for lumbar disc herniation.

Summary of Background Data. 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.

Methods. 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.

Results. 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.

Conclusion. 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.

Level of Evidence: 5

Spine Surgery and Research, Spine Center of Southern Denmark, Lillebaelt Hospital, Middelfart, Denmark

Center for Shared Decision Making, Lillebaelt Hospital, Vejle, Denmark

Institute of Regional Health Research, University of Southern Denmark, Odense, Denmark

§Health Services Research Unit, Lillebaelt Hospital, Vejle, Denmark.

Address correspondence and reprint requests to Stina Brogård Andersen, MHS, Centre for Spine Surgery and Research, Institute of Regional Health Research, University of Southern Denmark, Lillebaelt Hospital, Øster Hougvej 55, Denmark; E-mail:

Received 8 January, 2018

Revised 31 May, 2018

Accepted 4 June, 2018

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

No funds were received in support of this work.

Relevant financial activities outside the submitted work: board membership, consultancy, grants, employment, travel/accommodations/meeting expenses.

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