DEFORMITY

Patient and Spine Surgeon Perceptions on Shared Decision-Making in the Treatment of Older Adults Undergoing Corrective Surgery for Adult Spinal Deformity

Deme, Palvasha BA^a,b; Perera, Anjali BSN, RN^a,b; Chilakapati, Sai MS^a,b; Stutzman, Sonja PhD^a; Singh, Ravinderjit BS^a,b; Eldridge, Cody M. BS^a,b; Caruso, James BA, MD^a,b; Vira, Shaleen MD^a,b; Aoun, Salah G. MD^a,b; Makris, Una E. MD, Msc^c; Bagley, Carlos A. MD, MBA^a,b; Adogwa, Owoicho MD, MPH^a,b

Author Information

^aDepartment of Neurosurgery, University of Texas Southwestern Medical School, Dallas, TX

^bSpine Center, University of Texas Southwestern Medical School, Dallas, TX

^cDepartment of Internal Medicine, University of Texas Southwestern Medical School, Dallas, TX.

Address correspondenceand reprint requests to Owoicho Adogwa, MD, MPH, Assistant Professor, Department of Neurosurgery, University of Texas Southwestern Medical School, 5323 Harry Hines Avenue, CS7.410MC8855, Dallas, TX 75390-8855; E-mail: [email protected]

Received 28 June, 2021

Revised 2 September, 2021

Accepted 6 September, 2021

PD and AP are joint first authors.

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.

SPINE 47(10):p 730-736, May 15, 2022. | DOI: 10.1097/BRS.0000000000004257

Study Design.

Retrospective.

Objective.

To understand patients’ and spine surgeons’ perspectives about decision-making around surgery for adult spinal deformity.

Summary of Background Data.

Surgery for correction of adult spinal deformity is often beneficial; however, in over 20% of older adults (≥ 65 yrs of age), outcomes from surgery are less desirable.

Materials and Methods.

We conducted semistructured, in-depth interviews with six patients and five spine surgeons. Two investigators independently coded the transcripts using constant comparative method, as well as an integrative, team-based approach to identify themes.

Results.

Patients themes: 1) patients felt surgery was their only choice because they were running out of time to undergo invasive procedures; 2) patients mentally committed to surgery prior to the initial encounter with their surgeon and contextualized the desired benefits while minimizing the potential risks; 3) patients felt that the current decision support tools were ineffective in preparing them for surgery; and 4) patients felt that pain management was the most difficult part of recovery from surgery. Surgeons themes: 1) surgeons varied substantially in their interpretations of shared decision-making; 2) surgeons did not consider patients’ chronological age as a major contraindication to undergoing surgery; 3) there is a goal mismatch between patients and surgeons in the desired outcomes from surgery, where patients prioritize complete pain relief whereas surgeons prioritize concrete functional improvement; and 4) surgeons felt that patient expectations from surgery were often established prior to their initial surgery visit, and frequently required recalibration.

Conclusion.

Older adult patients viewed the decision to have surgery as time-sensitive, whereas spine surgeons expressed the need for recalibrating patient expectations and balancing the risks and benefits when considering surgery. These findings highlight the need for improved understanding of both sides of shared decision-making which should involve the needs and priorities of older adults to help convey patient-specific risks and choice awareness.

Level of Evidence.

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