Development of a patient decision aid for people with chronic low back pain and degenerative disc disease considering lumbar fusion: A mixed-methods study

Abstract

OBJECTIVES: To develop and user-test a patient decision aid providing evidence-based information for people with chronic low back pain (LBP) and degenerative disc disease considering lumbar fusion. DESIGN: Convergent parallel mixed methods study. SETTING: A prototype patient decision aid was developed, guided by the International Patient Decision Aid Standards (IPDAS) criteria, a multidisciplinary steering committee, and insights from previous studies. Participants were recruited via social media and the authors' collaborative networks to refine and evaluate the decision aid. PARTICIPANTS: Individuals who underwent lumbar fusion for chronic LBP and health professionals who manage these patients were purposively sampled. PRIMARY AND SECONDARY OUTCOMES: Semi-structured interviews and questionnaires were used to gather feedback and assess the decision aid's acceptability, usability, and preparedness for decision-making. Framework analysis was used for interview data and descriptive analysis for questionnaires. RESULTS: Sixteen clinicians (5 physiotherapists, 2 rheumatologists, 2 surgeons, 7 general practitioners) and seven patients participated, most rating the prototype's acceptability as 'excellent' or 'good'. Usability (mean [SD], health professionals: 78 [16], patients: 72 [8]) and preparedness for decision-making (health professionals: 73 [14], patients: 72 [10]) also scored highly. However, some viewed the prototype as biased against lumbar fusion, and suggestions to include more personalised information were made. CONCLUSIONS: This study showed that our prototype patient decision aid is acceptable, useful, and prepares patients to make informed decisions about spinal fusion for chronic LBP and degenerative disc disease. Future studies will assess the clinical impact of our decision aid and its optimal distribution timing.