Decisional Conflict Among Patients Considering Treatment Options for Lumbar Herniated Disc.

Abstract

Lumbar herniated disc is a "preference-sensitive" condition, in which the optimal treatment choice is crucially dependent on an informed patient's goals and values. Little is known about decisional conflict, defined as an individual's level of uncertainty regarding a decision, in patients considering treatment for lumbar herniated discs. Our work aims to identify factors associated with decisional conflict and areas for improved shared decision making. We prospectively surveyed patients seeking treatment for a lumbar herniated disc at L4-L5 and/or L5-S1 with a physician at the UCLA Spine Center. Decisional conflict was measured using the validated SURE questionnaire. We performed univariate and multivariate logistic analysis to identify predictors of decisional conflict. Among the 174 participants surveyed, 47% reported experiencing decisional conflict and 44% changed their treatment preference after the visit, with 61% of these opting for more invasive treatment. Participants with decisional conflict were less satisfied with their treatment decision (P < 0.001) and less willing to recommend their physician (P = 0.003) and physician's medical group to others (P = 0.003). Multivariate analysis revealed that participants were more likely to experience decisional conflict if they consulted with a physiatrist compared with a surgeon (odds ratio [OR], 2.6; P = 0.019) and if they did not feel able to discuss the various treatment options with the doctor during the visit (OR, 8.5; P < 0.001). Many patients with a lumbar herniated disc experience decisional conflict when choosing a treatment option. Our results highlight the need to implement tools and strategies to improve decisional quality, such as decision aids before consultation.