Involving patients in clinical decisions - Impact of an interactive video program on use of back surgery

BACKGROUND. Back surgery rates are rapidly rising in the United States. Thi s surgery is usually elective, so patient preferences are important in the treatment decision. OBJECTIVES. The objective of this study was to determine the impact on outc omes and surgical choices of an interactive, diagnosis-specific videodisk p rogram for informing patients about treatment choices, RESEARCH DESIGN. This was a randomized, controlled trial at 2 sites compari ng the interactive video plus a booklet with the booklet alone. SUBJECTS. Elective surgery candidates (n = 393) included 171 patients with herniated disks, 110 with spinal stenosis, and 112 with other diagnoses. MEASURES. Mailed questionnaires were used to assess outcomes and satisfacti on; surgery rates were determined by questionnaires and automated records. RESULTS. Symptom and functional outcomes at 3 months and 1 year were simila r between study groups. The overall surgery rate was 22% lower in the video disk group (26% versus 33%, P = 0.08). Among patients with herniated disks, those in the video group underwent significantly less surgery (32% versus 47%, P = 0.05 by Kaplan-Meier test). Among patients with spinal stenosis, s urgery rates in the video group were higher (39% for the video group, 29% f or the booklet group; P = 0.4). There was little effect on patient satisfac tion, but patients in the video group felt better informed. CONCLUSIONS. The program appears to facilitate decision making and may help to ensure informed consent. For patients with herniated disks, it reduced the surgery rate without diminishing patient outcomes. Its impact on costs of care depends on the proportion of patients with various diagnoses and on local surgery rates.