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Discrepancies Between Patient and Surgeon Expectations of Surgery for Sciatica

A Challenge for Informed Decision Making?

Rehman, Yasir, MD, MSc, PhD (C)∗,†,‡; Syed, Muzammil, BSc§; Wiercioch, Wojtek, MSc, PhD; Rehman, Nadia, BDS; Drew, Brian, MD, FRCS||; Cenic, Aleksa, MD, FRCS||; Reddy, Kesava, MD, FRCS||; Murty, Naresh, MD, FRCS||; Kucher, Edward, MD, FRCS||; Dunlop, Brett, MD, FRCS||; Guyatt, Gordon H., MD, MSc, FRCP∗,∗∗; Busse, Jason W., DC, PhD∗,†,††,‡‡; Schwartz, Lisa, PhD∗,§§; Vanstone, Meredith, PhD∗,¶¶

doi: 10.1097/BRS.0000000000002914
HEALTH SERVICES RESEARCH
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Study Design. Qualitative study.

Objective. The objective of this study was to compare the perceptions of patients and surgeons regarding the risks and benefits of lumbar decompressive surgery for sciatica following a consultation meeting.

Summary of Background Data. Evidence regarding pain improvement in patients following lumbar decompressive surgery for sciatica is inconsistent. Given this inconsistency, patients choosing to undergo lumbar decompressive surgery must accept the risks associated with the surgery despite uncertainty regarding benefits. This raises questions as to the nature of informed decision-making for patients choosing to undergo surgery for sciatica.

Methods. We undertook a qualitative descriptive study with 12 adult lumbar decompressive surgery candidates and six of their spine surgeons and analyzed data using inductive content analysis.

Results. Our analysis revealed that most patients were satisfied with the consultation despite limited understanding of lumbar decompressive surgery. We found discrepancies between patients’ preoperative expectations and understanding of information provided by surgeons and what surgeons believed they had conveyed. Surgeons and patients disagreed on how much information is needed about postsurgical activity modifications and long-term outcomes to make a decision about whether or not to undergo surgery, with patients desiring more information. As a result, for most patients, the decision-making process extended beyond the information provided by surgeons and incorporated information from family members, friends, family doctors, and the internet.

Conclusion. Our results highlight misunderstandings between patients and surgeons, particularly in regard to prognosis and activity modifications. Since this information is important for patients choosing whether to undergo a surgical intervention, our study provides guidance to improve informed decisions about sciatica and, potentially, other elective surgeries.

Level of Evidence: 4

In this qualitative study, we found discrepancies between patient's expectations and understanding of decompression for sciatica and information provided by surgeons. There is a need for improved communication between patients and their surgeon to provide realistic expectations about lumbar decompression optimize informed decision making by patients.

Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada

The Michael G. DeGroote Institute for Pain Research and Care, McMaster University, Hamilton, Ontario, Canada

Canadian Academy of Osteopathy, Hamilton, Ontario, Canada

§Department of Health Sciences, McMaster University, Hamilton, Ontario, Canada

Health Informatics, Center for Continuing Education, McMaster University, Hamilton, Ontario, Canada

||Department of Surgery, McMaster University, Hamilton, Ontario, Canada

∗∗Department of Medicine, McMaster University, Hamilton, Ontario, Canada

††Department of Anesthesia, McMaster University, Hamilton, Ontario, Canada

‡‡The Michael G. DeGroote Centre for Medicinal Cannabis Research, McMaster University, Hamilton, Ontario, Canada

§§Centre for Health Economics and Policy Analysis, McMaster University, Hamilton, Ontario, Canada

¶¶Department of Family Medicine, McMaster University, Hamilton, Ontario, Canada.

Address correspondence and reprint requests to Yasir Rehman, MD, MSc, PhD, Department of Health Research Methods, Evidence and Impact, The Michael G. DeGroote Institute for Pain Research and Care, McMaster University, Hamilton, Ontario, Canada, L8S 4K1; E-mail: rehmany@mcmaster.ca

Received 1 June, 2018

Revised 8 September, 2018

Accepted 3 October, 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: grants.

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