DOS 2018

DOS Kongressen 2018 · 239 Factors affecting patient decision-making on surgery for lumbar disc herniation Stina Andersen, Regner Birkelund, Mikkel Andersen, Leah Carreon, Karina Dahl Steffensen Spine Surgery and Research, Spine Center of Southern Denmark, Lillebaelt Hospital, Middelfart, Denmark; Health Services Research Unit, Lillebaelt Hospital, Vejle, Denmark; Spine Surgery and Research , Lillebaelt Hospital, Middelfart, Denmark; Center for Shared Decision Making , Lillebaelt Hospital, Vejle, Denmark Background: The decision about if and when to have surgery for lumbar disc herniation (LDH) when no major neurological deficits are present can be com- plex. Considering the inconclusive evidence regarding the timing of surgery and ambiguous evidence on long term outcomes it is essential to involve patients in decision-making before potential surgery. Purpose / Aim of Study: To explore from a patient perspective what affect the decision-making process on whether or not to have surgery for symptom- atic LDH. Materials and Methods: Fourteen candidates for primary surgery due to LDH were interviewed. A hermeneutic-phenomenological approach was used to un- cover the process of decision-making as it was experienced by the patients through their life-world stories. All interviews were transcribed and analyzed using a meaning- condensation method. Natural meaning units were identified and categorized in to four main themes. Data were analyzed in a theoretical perspective of Shared Decision-making. Findings / Results: Four main themes appeared to influence the patients’ de- cision-making process: Patient information: Patients’ conceptions about treat- ment and risk were not always based on sufficient information and could affect their initial preference for treatment. Accelerated workflows: some patients needed time to process the information given, which may be limited due to accelerated hospital workflows. Power imbalance: patients can be reluctant to challenge the system, as they do not want to offend, which can be seen as a power imbalance between clinicians and patients. Personal past experience: ex- perience from relatives can have a great impact on the patients’ thoughts about possible treatments. Conclusions: Understanding these complex factors that influence the decision- making process will hopefully help surgeons to better support patients choosing treatment for LDH. 180.