Preference Sensitive Care and Shared Decision-Making in Lumbar Spinal Stenosis

Abstract

Study Design. Scoping Review. Objective. The objective of this study was to conduct a scoping review exploring the extent to which preference sensitivity has been studied in treatment decisions for LSS, utilizing shared decision making (SDM) as a proxy. Summary of Background Data. Preference-sensitive care involves situations where multiple treatment options exist with significant tradeoffs in cost, outcome, recovery time, and quality of life. Lumbar spinal stenosis (LSS) has gained research focus as a preference-sensitive care scenario. Methods. A scoping review protocol in accordance with PRISMA-ScR regulations was registered with the Open Science Framework (ID: 9ewup) and conducted across multiple databases from January 2000 to October 2022. Study selection and characterization were performed by three independent reviewers and an unbiased moderator. Results. The search resulted in the inclusion of 16 studies varying in design and sample size, with most published between 2016 and 2021. The studies examined variables related to SDM, patient preferences, surgeon preferences, and decision aids. The outcomes assessed included treatment choice, patient satisfaction, and patient understanding. Several studies reported that SDM influenced treatment choice and patient satisfaction, while the impact on patient understanding was less clear. Decision aids were used in some studies to facilitate SDM. Conclusion. The scoping review identified a gap in comprehensive studies analyzing the preference sensitivity of treatment for LSS and the role of decision aids. Further research is needed to better understand the impact of patient preferences on treatment decisions and the effectiveness of decision aids in LSS care. This review provides a foundation for future research in preference-sensitive care and SDM in the context of lumbar stenosis treatment. Level of Evidence. N/A Scoping Review

Artificial intelligence: promise and peril in achieving the quadruple aim in healthcare

“…In the absence of health insurance reform, technological transformation of healthcare and using AI (artificial intelligence) to achieve the quadruple aim may improve healthcare efficiency in four ways (summarized in the Table 1). conditions -like lumbar spinal stenosis, where medical and surgical treatment options offer different short-and long-term risks and benefits (Asthana et al, 2024) -but can also be useful in acute care settings, as when patients are admitted to an Intensive Care Unit where issues of outcomes and futility might arise (Göcking et al, 2023). However, decision aids are under-used (The Commonwealth Fund, 2024).…”

“…Informed choice can change the dynamics of decision making and empowering well-informed consumers with objective information about treatment options, potential risks and benefits of different options, and the degree to which their choices align with their own values (Stacey et al, 2017 ). Decision aids are particularly helpful in preference-sensitive conditions – like lumbar spinal stenosis, where medical and surgical treatment options offer different short- and long-term risks and benefits (Asthana et al, 2024 ) – but can also be useful in acute care settings, as when patients are admitted to an Intensive Care Unit where issues of outcomes and futility might arise (Göcking et al, 2023 ). However, decision aids are under-used (The Commonwealth Fund, 2024 ).…”