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Clinical Decisionmaking

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Patients can use an interactive video program to help them make decisions about back surgery

Back surgery rates are rising rapidly in the United States. This surgery is usually elective, so patient preferences are important in the treatment decisions. Patient decisions about back surgery can be informed and influenced by an interactive video, finds a study supported in part by the Agency for Healthcare Research and Quality (HS08079). Patients with herniated disks who watched an interactive video program about the costs and benefits of back surgery for their problem and received a booklet about the topic were less likely to choose back surgery than those who only received the booklet. Outcomes for both groups were similar.

Patients who chose to forego back surgery as a result of watching the video program apparently made good decisions for themselves, notes Richard A. Deyo, M.D., M.P.H., of the University of Washington. Dr. Deyo and his colleagues compared the surgical decisions and outcomes of elective surgery candidates (171 with herniated disks, 110 with spinal stenosis, and 112 with other back diagnoses) at two sites. One group saw an interactive video and received an educational booklet about surgery for their condition, the other group received only a booklet.

Symptom and functional outcomes at 3 months and 1 year were similar for the two groups, but the overall surgery rate was 22 percent lower in the video group (26 vs. 33 percent). Patients with herniated disks in the video group who learned that their problem usually improves with nonsurgical care underwent significantly less surgery (32 vs. 47 percent) than the booklet-only group. Patients with spinal stenosis in the video group found out that without surgery their condition would probably stay about the same for many years. They had higher surgery rates (39 vs. 29 percent) than the booklet-only group. The video had little effect on patient satisfaction, but patients in the video group felt better informed than patients in the other group. Thus, patients who are well-informed about their medical choices and expected outcomes may choose fewer surgeries for herniated disks without harm, and they may choose surgery for spinal stenosis more often than otherwise.

More details are in "Involving patients in clinical decisions: Impact of an interactive video program on use of back surgery," by Dr. Deyo, Daniel C. Cherkin, Ph.D., James Weinstein, D.O., M.S., and others in Medical Care 38(9), pp. 959-969.

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