SUPPORTING PATIENT DECISION-MAKING FOR SURGERY VERSUS PROLONGED CONSERVATIVE TREATMENT FOR HERNIATED DISK: EVALUATION OF ENRICHED VIDEO AND TEXTUAL WEB-BASED PATIENT DECISION AIDS IN A MULTI-CENTER RANDOMIZED TRIAL

For patients with sciatica caused by lumbar-disk herniation lasting >6 weeks, two treatment options are early lumbar-disk surgery and prolonged conservative care, with eventual surgery if needed. Whereas pain relief and perceived recovery are faster for patients receiving early surgery than for those receiving prolonged conservative treatment, the 1-year outcomes are similar. Since surgery entails risks, patients therefore face a preference-sensitive treatment decision and may benefit from a decision aid aimed at supporting them to make a well-informed choice that fits their personal circumstances and preferences.    

Purpose:  To determine the effectiveness of two versions of a web-based decision aid with similar information provision levels, compared to conventional information provision, in supporting patient decision making for for Sciatica treatment.    

Methods:  In this multicenter randomized trial, 111 patients with lumbar disk herniation-related sciatica lasting >6 to 8 weeks were recruited from 9 Dutch hospitals and randomly assigned to one of three conditions: a textual or an enriched video-format web-based decision aid, or conventional patient information provision (standard patient information letter).  A questionnaire was administered three times (T1: after first visit to neurologist, T2: after receiving the decision aid, and T3: a week after second visit to neurologist) to patients, assessing patients’ feelings of being well-informed as well as patients’ feelings of anxiety and depression.   

Results:  The main findings show that patients in both decision aid groups felt better informed about their options compared to patients receiving conventional information only. Moreover, compared to the conventional information condition, the textual-format decision aid increased, but the enriched video-format decision aid decreased levels of anxiety and depression.    

Conclusion:  These findings highlight that different formats of decision aids equal in level of information provision both increase patients’ feelings of being well-informed, but differentially affect feelings of anxiety and depression. Providing patients with a textual-format decision aid may result in an increased need for patients to meet with a health care provider in order to alleviate feelings of anxiety and depression. It is likely that this need is decreased when patients receive the enriched, video-format decision aid. Hence, the enriched, video-format decision aid seems most effective in terms of patients’ quality of life and costs of health care.    Keywords:  Decision aids, (Lumbar) disk herniation, Surgery versus prolonged conservative treatment, Multicenter randomized trial