2nd Study Also Finds Gap Between Patient and Surgeon Perceptions

The topic of how a patient perceives shared decision-making versus how their surgeon perceives it is getting increased attention from the research community. Here comes a second study—this time in spine care and from a different institution than the University of Texas Dell School of Medicine work—which found that patients and their spine surgeons have differing perceptions on shared decision-making on surgery.

The study, “Patient and Spine Surgeon Perceptions on Shared Decision-Making in the Treatment of Older Adults Undergoing Corrective Surgery for Adult Spinal Deformity,” was published in the May 15, 2022 issue of the journal Spine.

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

Because of this, they wanted to better understand patients’ and spine surgeons’ perspectives about decision-making around surgery for adult spinal deformity.

The researchers conducted semi structured, in-depth interviews with six patients and five spine surgeons to identify themes.

Patient themes included that the patients felt surgery was their only option because soon they wouldn’t be able to undergo invasive procedures anymore; they mentally committed to the surgery even before their first meeting with the surgeon; they felt that the current decision support tools were ineffective in preparing them for surgery; and they felt that pain management was the most difficult part of the recovery after surgery.

Surgeon themes included that the surgeons had significant different interpretations of shared decision-making; they didn’t consider a patient’s chronological age as a major contraindication to undergoing surgery; patients and surgeons have mismatched goals when it comes to the desired outcomes of the surgery–for patients their goal is complete pain relief while for surgeons the more important goal is functional improvement.

In addition, the surgeons felt that patient expectations from surgery were often established prior to their first meeting and frequently required adjustment.

“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,” the researchers wrote.

Study authors include Palvasha Deme, B.A., Anjali Perera, BSN, RN, Sai Chilakapati, M.S., Sonja Stutzman, Ph.D., Ravinderjit Singh, B.S., Cody Eldridge, B.S., James Caruso, M.D., Shaleen Vira, M.D., Salah G. Aoun, M.D., Una E. Makris, M.D., Msc., Carlos A. Bagley M.D., M.B.A., and Owoicho Adogwa, M.D., MPH, all of the University of Texas Southwestern Medical School in Dallas, Texas.