Video Helps Pain Patients Make Decisions about Surgery

Findings from a study published in Spine indicate that viewing an evidence-based video can assist patients with low back pain in making decisions about whether to undergo surgical versus nonsurgical treatment.

“The video helped those patients who were uncertain at baseline to form a preference, and helped those patients who started with an initial preference to strengthen their preference,” said lead researcher Jon D. Lurie, MD, MS, of Dartmouth Medical School.

In the study, Dr. Lurie and colleagues analyzed data from 2500 patients with intervertebral disc herniation, spinal stenosis, or degenerative spondylolisthesis who were enrolled in the Spine Patient Outcomes Research Trial (SPORT) at 13 multidisciplinary spine centers across the United States. Participants were offered the opportunity to view a video decision aid to help them decide between surgical and nonsurgical treatment. The videos provided information on the research-based evidence for surgical versus nonsurgical treatment for the patient’s specific cause of back pain. According to the study, 86% of the patients watched the videos.

The results suggested that patients who watched the video were more likely to shift their preferences. About 38% of those who viewed the video changed their treatment preferences, compared to 21% of those who did not watch the video.

For patients whose preference shifted after watching the video, 55% shifted toward surgery. Watching the video was also more likely to strengthen the patients’ preferences, whether they initially preferred surgical or nonsurgical treatment. Of patients who started with no preference, 27% opted for nonsurgical treatment and 22% chose surgery after watching the video; the remaining 51% remained uncertain.

“There was no consistent trend in preference shifts either toward or away from surgery, suggesting that the decision aid had a balanced effect on treatment preferences,” the authors wrote. “It did not appear to be biased either for or against one treatment approach.”

Videos are one type of decision aid being investigated to help patients make shared treatment decisions. Studies suggest that decision aids can improve knowledge, create more realistic expectations, reduce conflict, and help patients be more actively involved in decision-making.

Viewing an evidence-based decision-aid video help patients form or strengthen their preference for surgical versus nonsurgical treatment for low back pain, the study results suggest. “Unbiased, evidence-based decision aids such as these can be useful tools to help patients with lumbar spine disorders participate with their physicians in making an informed choice regarding whether or not to have spine surgery,” the authors concluded.