Background: Video-based patients' decision aids (PtDAs) for individuals considering elective back surgery for herniated disc / spinal stenosis have been successfully tested in RCT studies. However, their implementation in “real time” could be handicapped by failing to understand orthopaedic surgeons' opinions about these back surgery PtDAs.

Purpose: To determine orthopaedic surgeons' opinions about: the basic idea of PtDAs; feasible media and practice models for disseminating PtDAs; and specific ways in which PtDAs might be helpful in actual practice.

Methods: We contacted, by e-mail, fax, and surface mail, all 2430 available members of the American Academy of Orthopaedic Surgeons (AAOS) who perform elective back surgery for herniated disc / spinal stenosis. Decision support for back surgery with PtDAs was outlined, then a questionnaire assessed their opinions. Responses were obtained by e-mail (7%), fax (29%), surface mail (32%), and on a designated website (32%).

Results: 629 eligible surgeons responded (target = 520). 88% consider using back surgery PtDAs a “good/excellent” idea; 51% favoured booklets + audiotapes over other media; and 85% favoured providing the PtDA at the 1st consultation for the patient to view at home followed by discussion of the options and decision making at the 2nd consultation. Majorities considered PtDAs most helpful if they: a) increase patients' comprehension [of options, benefits, and risks (88-91%)]; b) help with clinic work flow [time for answering patients' questions and clarifying preferences (81-82%)]; c) foster the patient-MD relationship [matching preferences, high-quality communication, increased patient confidence]; and d) positively affect patients' anxiety (80%), depression (53%), quality of life (65%), adherence to treatment (75%), and satisfaction with care (85%). Majorities indicated they would use PtDAs if they reduced malpractice insurance and local litigation rates (87-88%), if health insurers reimbursed surgeons for their use (83%), and if PtDA use served as a Quality Assurance indicator (79%).

Conclusions: These observations carry a wide range of implications for: a) designing and disseminating back surgery PtDAs; b) creating CME programs; and c) developing new measures of the effectiveness of PtDA implementation from the orthopaedic surgeons' perspective.