Authors (including presenting author) :
Wong CK(1). LAM WWK(2), LOKE AY(3), LUK BHK(2)
Affiliation :
(1) Department of Orthopaedic and Traumatology, United Christian Hospital, (2) School of Nursing and Health Studies, Hong Kong Metropolitan University, (3) School of Nursing, Hong Kong Polytechnic University
Introduction :
Spinal degenerations progress slowly and often present as asymptomatic. Different from acute clinical situation where treatment is urgently required, patients are capable of making treatment decision promptly. However, when there is slow progression of symptoms, in particular with controversial treatment outcomes, patients may find it difficult to make a decision on treatment options. Medical information is crucial for patients to arrive at a more aggressive treatment decision such as spinal surgery. Patients are more likely to make treatment decisions based on their personal concerns or preference, and if the treatment and outcomes are likely to meet their expectations. In other words, information received from clinicians provide patients with an initial understanding of their condition and the surgical procedure, the patients will then take into account their personal preference and if the treatment option is appropriate in meeting their expectations of treatment outcomes.
Objectives :
To explore intrapersonal factors associated with decision of patients with degenerative back pain when considering for surgery. This study also assess the readiness of patients suffering from degenerative back pain for a surgical treatment, and aims to understand patients' information needs, their expectation and treatment preferences.
Methodology :
From September 2018 to May 2019, patients who attended the Spine Nurse Clinic in United Christian Hospital, were invited to complete a questionnaire. Patients who decided for (case) and declined surgery (control) were confirmed from medical records after. This was a case-control survey to explore the intrapersonal factors: (1) the information needs, (2) the expectations of treatment outcomes, and (3) the treatment preferences of patients with degenerative back pain considering spinal surgery.
Result & Outcome :
Seventy-five patients were recruited. Male patients (75.0%, p = 0.019), those were married (78.7%, p = 0.0045), and had spousal care-givers (89.2%, p < 0.0001) were more likely to decide for surgery. All patients who decided for surgery expressed need for information on “the severity of their spine conditions” (p = 0.039). Those who decided for surgery did not have as the high expectation on “to sleep more comfortably” as those who declined (4.71 vs. 4.91, p = 0.022). The predictive factors for surgery decision by logistic regression analysis were: male gender (OR = 3.23, 95% CI: 1.19 - 8.77, p = 0.021); married (OR = 5.231, 95% CI: 1.87 – 14.61, p = 0.002); with available spousal care-giver (OR = 1.85, 95% CI: 0.198 – 3.89, p = 0.031); and those who preferred to treat/cure spine disorder by pharmacological treatment (OR = 2.77, 95% CI: 1.02 - 7.50, p = 0.045). Patients who decided surgery were likely to indicate need of medical information related to their "severity" of spinal diseases. Patients were in hope of better relief of physical symptoms, especially related to sleep comfort. Patients would escalate their treatment from conservative to surgery when they considered conservative treatments were no longer effective.
