D-6 DOES HEALTH COACHING AFFECT THE DECISION PROCESS FOR PATIENTS CHOOSING A SPINAL STENOSIS TREATMENT?

Thursday, October 18, 2012: 5:45 PM
Regency Ballroom A/B (Hyatt Regency)
Decision Psychology and Shared Decision Making (DEC)

Susan Berg, MS, CGC1, Stephen Kearing, MS2, Jon Lurie, MD, MS1, Sherry Thornburg, MPH3, William Abdu, MD, MS1, Sohail Mirza, MD, MPH1, Martha Travis-Cook1 and Dale Collins Vidal, MD, MS1, (1)Dartmouth Hitchcock Medical Center, Lebanon, NH, (2)Geisel School of Medicine, Lebanon, NH, (3)The Dartmouth Institute, Center for Informed Choice, Lebanon, NH

Purpose:   Treatment options for lumbar spinal stenosis include surgical and non-surgical approaches.  Decision support in the form of coaching may help patients deliberate about their treatment options.  The goal of this study is to assess the impact of coaching on the decision process for patients considering their treatment options for spinal stenosis.

Method: Patients with spinal stenosis referred by a spine specialist for decision support are randomly assigned to either:  decision aid (DA only, usual care) or decision aid + health coaching by telephone (DA+HC, intervention group).  Enrolled participants complete questionnaires at: baseline, after watching the video decision aid, at two weeks after DA, and at 6 months.  Measures - patient demographic characteristics (age, gender, and education), stage of decision making, treatment choice, treatments received, and decisional regret.

Result: To date, 117 participants have completed baseline and follow up questionnaires (58 DA only / 59 DA+HC).  Average age 67.1 years, 49% female, 60% had at least some college.    Both groups showed similar progress in decision making after watching the DA (Table 1).  More patients in the coaching group had made a treatment decision at the two week follow up (DA+HC 75% vs. DA only 48%, p=0.001).  The uptake of surgery was similar for both groups (DA only (11/58 - 19%) had surgery vs. DA+HC (12/59 - 20%); however at the 6 month follow-up point  more coaching participants had implemented the treatment chosen at 2 weeks (64% of DA only participants followed through with their choice vs. 80% of DA+HC patients, p=0.03).  Few patients indicated regret about their treatment (DA only, 5% vs. DA+HC 7%) at 6-month follow up.

Conclusion: The preliminary results from this ongoing study suggest similar treatment uptake and low levels of regret with treatment choice for both study groups.  The addition of a telephone coaching session appears to help some participants arrive at a decision more quickly and follow through with their chosen option.