Authors (including presenting author) :
Wong CK(1), Lam WWK(2), Cheng HC(1), Wong NM(1), Kong CY(1), Loke AY(3)
Affiliation :
(1) Department of Orthopaedic & Traumatology, United Christian Hospital
(2) School of Nursing, The University of Hong Kong
(3) School of Nursing, The Hong Kong Polytechnic University
Introduction :
Spinal disorders are common in populations with or without severe symptomatic illness. Treatment of spinal disorder commonly starts on conservative options. In the hope to achieving better functional outcomes, clinicians are suggesting surgery in early stage of spinal dysfunctions. However, spinal disorders often present with slow disease progression which could hinder patients' prompt decision for surgery.
Objectives :
To explore patients’ treatment preferences and expectations, and information needs for spinal surgery decision.
Methodology :
A survey was conducted among 75 patients who attended specialty nurse clinic from September 2018 to May 2019. A questionnaire was developed to solicit the patients’ preference to treatment modalities, their expectation measured by the Musculoskeletal Outcomes Evaluation and Management System (MODEMS) and their information needs. Logistic regression was conducted to assess the predictive patient preference and expectation factors to surgery decision
Result & Outcome :
Results:
More patients who finally opted for surgery showed initial preference for pharmacological treatment (73.5%,) when compared with surgery (71.4%) and physiotherapy (71.4%, p < 0.05). All patients reported high level of MODEMS expectations scores (4.57 to 4.78 out of the possible score of 5) in all six treatment outcomes: (1) relief from symptoms [4.75/5] ; (2) do more household or yard activity [4.69/5]; (3) sleep comfortably [4.78/5] ; (4) back to usual job [4.60/5] ; (5) do more exercise and recreational activity[4.57/5] and (6) prevent future disability [4.61/5].
Logistic regression showed patients initially preferred pharmacological treatment were three times (OR=2.77, p < 0.05) more likely to accept surgery as definite treatment for their spinal disorders. A high percentage of patients (84% to 100%) desired for more information for the surgical decision, such as post-operation lifestyle change (100%), accurate diagnosis (98.7%), necessity for operation (97.3%) and efficacy of pharmacological treatment (84%). More patients who opted for surgery expressed information need for “the severity of my spine conditions” than those opted not to have surgery (100% vs. 88.5%, p < 0.05).
Conclusions:
The findings of this study revealed that patients generally accept surgery, pharmacological treatment and physiotherapy, but when patients preferred pharmacological treatment, they were more likely to opt for surgery after their medical and specialty nurse consultation. All patients were hoping to receive more information to facilitate the process in making the treatment decision.
