Monday, October 24, 2011
Grand Ballroom AB (Hyatt Regency Chicago)
Poster Board # 9
(DEC) Decision Psychology and Shared Decision Making

Susan Berg, MS, CGC1, Sherry Thornburg, MPH2, Jon Lurie, MD1, Stephen Kearing, MS3, Kate F. Clay, MA, BSN1, William Abdu, MD1, Sohail Mirza, MD1, Harold Sox, MD4, Kevin F. Spratt, PhD1, Martha Travis-Cook1 and Dale Collins Vidal, MD, MS1, (1)Dartmouth Hitchcock Medical Center, Lebanon, NH, (2)The Dartmouth Institute, Center for Informed Choice, Lebanon, NH, (3)Dartmouth Medical School, Lebanon, NH, (4)The Dartmouth Institute, Lebanon, NH

Purpose:   Treatment options for lumbar spinal stenosis (SS) include surgical and non-surgical approaches.  Decision support coaching develops patients’ skills in preparing for a consultation and deliberating about their options.    The goal of this study is to assess the impact of telephone coaching on knowledge and decisional conflict for patients considering their treatment options for SS.

Method:    Patients with SS are referred by a spine specialist for decision support and are randomly assigned to either:  decision aid (DA, usual care) or decision aid + telephone health coaching (DA+HC, intervention group).  Coaching time has varied from 15-60 minutes.  Participants complete questionnaires at: baseline, after watching the video DA, 2 week follow up, and at 6 months.  Measures:  Patient demographics (e.g., age, gender, and education); Understanding of SS treatment options based on a 3-time multiple choice test; decisional conflict scale (DCS); and coaching status.

Result:   To date, 68 patients have enrolled (32 DA only / 36 DA+HC). 26 DA only and 27 DA + HC have completed surveys through the 2 week follow-up.  Average age 64.2, 57% female, 61% had at least some college.    Both groups showed improved understanding of spinal stenosis treatments after watching the DA (paired t-test, p < 0.001).  DA only patients showed a decrease in knowledge scores over time (after DA 78% vs. follow up 57%, p=0.008); while coaching patients tended to retain their knowledge of key facts surrounding the decision (after DA 61% vs. follow up 62%). Patients showed improvements in decisional conflict after watching the DA (paired t-test, p ≤ 0.01); at two weeks, patients who received coaching  showed an additional small improvement in decisional conflict (DCS=17 vs. DCS=9, p = 0.07).


DA only (n=26)

DA+HC (n=27)

Mean score (95% clm)


After DA

Follow up


After DA

Follow up

Knowledge (% correct)

26% (18-34)

78% (71-84)

57% (45-69)

25% (18-32)

61% (50-72)

62% (51-73)

Decisional conflict

39 (29-49)

15 (8-21)

15 (8-22)

31 (22-40)

17 (7-27)

9 (3-16)

Conclusion:   The preliminary results from this ongoing study suggest that the DA intervention improved understanding of key facts and helped these patients by reducing decisional conflict about their treatment choice.  Whether the addition of health coaching improves decision making for SS patients who receive a decision aid remains to be seen.