Patient experiences of decision-making in the treatment of spinal metastases: a qualitative study.
Decision making
Provider communication
Qualitative research
Radiation oncology
Spinal metastases
Surgical management
Journal
The spine journal : official journal of the North American Spine Society
ISSN: 1878-1632
Titre abrégé: Spine J
Pays: United States
ID NLM: 101130732
Informations de publication
Date de publication:
06 2020
06 2020
Historique:
received:
07
08
2019
revised:
21
11
2019
accepted:
27
12
2019
pubmed:
4
1
2020
medline:
30
6
2021
entrez:
4
1
2020
Statut:
ppublish
Résumé
In the treatment of spinal metastases the risks of surgery must be balanced against potential benefits, particularly in light of limited life-expectancy. Patient experiences and preferences regarding decision-making in this context are not well explored. We performed a qualitative study involving patients receiving treatment for spinal metastatic disease. We sought to understand factors that influenced decision-making around care for spinal metastases. Three tertiary academic medical centers. We recruited patients presenting for treatment of spinal metastatic disease at one of three tertiary centers in Boston, MA. We conducted semistructured interviews using a guide that probed participants' experiences with making treatment decisions. We performed a thematic analysis that produced a list of themes, subthemes, and statement explaining how the themes related to the study's guiding questions. Patients were recruited until thematic saturation was reached. We interviewed 23 participants before reaching thematic saturation. The enormity of treatment decisions, and of the diagnosis of spinal metastases itself, shaped participant preferences for who should take responsibility for the decision and whether to accept treatments bearing greater risk of complications. Pre-existing participant beliefs about decision-making and about surgery interacted with the clinical context in a way that tended to promote accepting physician recommendations and delaying or avoiding surgery. The diagnosis of spinal metastatic disease played an outsized role in shaping participant preferences for agency in treatment decision-making. Further research should address strategies to support patient understanding of treatment options in clinical contexts-such as spinal metastases-characterized by ominous underlying disease and high-risk, often urgent interventions.
Sections du résumé
BACKGROUND
In the treatment of spinal metastases the risks of surgery must be balanced against potential benefits, particularly in light of limited life-expectancy. Patient experiences and preferences regarding decision-making in this context are not well explored.
PURPOSE
We performed a qualitative study involving patients receiving treatment for spinal metastatic disease. We sought to understand factors that influenced decision-making around care for spinal metastases.
STUDY SETTING
Three tertiary academic medical centers.
PATIENT SAMPLE
We recruited patients presenting for treatment of spinal metastatic disease at one of three tertiary centers in Boston, MA.
OUTCOME MEASURES
We conducted semistructured interviews using a guide that probed participants' experiences with making treatment decisions.
METHODS
We performed a thematic analysis that produced a list of themes, subthemes, and statement explaining how the themes related to the study's guiding questions. Patients were recruited until thematic saturation was reached.
RESULTS
We interviewed 23 participants before reaching thematic saturation. The enormity of treatment decisions, and of the diagnosis of spinal metastases itself, shaped participant preferences for who should take responsibility for the decision and whether to accept treatments bearing greater risk of complications. Pre-existing participant beliefs about decision-making and about surgery interacted with the clinical context in a way that tended to promote accepting physician recommendations and delaying or avoiding surgery.
CONCLUSIONS
The diagnosis of spinal metastatic disease played an outsized role in shaping participant preferences for agency in treatment decision-making. Further research should address strategies to support patient understanding of treatment options in clinical contexts-such as spinal metastases-characterized by ominous underlying disease and high-risk, often urgent interventions.
Identifiants
pubmed: 31899375
pii: S1529-9430(19)31156-8
doi: 10.1016/j.spinee.2019.12.018
pmc: PMC7246131
mid: NIHMS1548017
pii:
doi:
Types de publication
Journal Article
Research Support, N.I.H., Extramural
Langues
eng
Sous-ensembles de citation
IM
Pagination
905-914Subventions
Organisme : NIAMS NIH HHS
ID : K23 AR071464
Pays : United States
Organisme : NIAMS NIH HHS
ID : K24 AR057827
Pays : United States
Organisme : NIAMS NIH HHS
ID : P30 AR072577
Pays : United States
Informations de copyright
Copyright © 2019 Elsevier Inc. All rights reserved.
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