Emma C Lape1, Jeffrey N Katz1, Justin A Blucher1, Angela T Chen1, Genevieve S Silva1, Joseph H Schwab2, Tracy A Balboni3, Elena Losina1, Andrew J Schoenfeld4. 1. Department of Orthopedic Surgery, Brigham and Women's Hospital, Harvard Medical School, 75 Francis St, Boston, MA 02115, USA. 2. Department of Orthopedic Surgery, Massachusetts General Hospital, Harvard Medical School, 55 Fruit St, Boston, MA 02214, USA. 3. Department of Radiation Oncology, Brigham and Women's Hospital, Harvard Medical School, 75 Francis St, Boston, MA 02115, USA. 4. Department of Orthopedic Surgery, Brigham and Women's Hospital, Harvard Medical School, 75 Francis St, Boston, MA 02115, USA. Electronic address: ajschoen@neomed.edu.
Abstract
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.
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.
Authors: Jordan R Covvey; Khalid M Kamal; Erin E Gorse; Zumi Mehta; Trupti Dhumal; Elham Heidari; Deepika Rao; Christopher Zacker Journal: Support Care Cancer Date: 2019-02-08 Impact factor: 3.603
Authors: Andrew J Schoenfeld; Marco L Ferrone; Peter G Passias; Justin A Blucher; Lauren B Barton; John H Shin; Mitchel B Harris; Joseph H Schwab Journal: Spine J Date: 2019-05-22 Impact factor: 4.166
Authors: C Rory Goodwin; Andrew J Schoenfeld; Nancy A Abu-Bonsrah; Tomas Garzon-Muvdi; Eric W Sankey; Mitchel B Harris; Daniel M Sciubba Journal: Spine J Date: 2016-04-11 Impact factor: 4.166
Authors: David Choi; Zoe Fox; Todd Albert; Mark Arts; Laurent Balabaud; Cody Bunger; Jacob M Buchowski; Maarten H Coppes; Bart Depreitere; Michael G Fehlings; James Harrop; Norio Kawahara; Juan A Martin-Benlloch; Eric M Massicotte; Christian Mazel; Fetullah C Oner; Wilco Peul; Nasir Quraishi; Yasuaki Tokuhashi; Katsuro Tomita; Jorit Jan Verlaan; Michael Wang; H Alan Crockard Journal: Neurosurgery Date: 2015-11 Impact factor: 4.654
Authors: Patti Shih; Frances Rapport; Anne Hogden; Mia Bierbaum; Jeremy Hsu; John Boyages; Jeffrey Braithwaite Journal: BMC Health Serv Res Date: 2018-10-25 Impact factor: 2.655
Authors: Grace X Xiong; Miles W A Fisher; Joseph H Schwab; Andrew K Simpson; Lananh Nguyen; Daniel G Tobert; Tracy A Balboni; John H Shin; Marco L Ferrone; Andrew J Schoenfeld Journal: Spine (Phila Pa 1976) Date: 2022-04-01 Impact factor: 3.468
Authors: Lauren B Barton; Kaetlyn R Arant; Justin A Blucher; Danielle L Sarno; Kristin J Redmond; Tracy A Balboni; Matthew Colman; C Rory Goodwin; Ilya Laufer; Rick Placide; John H Shin; Daniel M Sciubba; Elena Losina; Jeffrey N Katz; Andrew J Schoenfeld Journal: J Bone Joint Surg Am Date: 2021-01-06 Impact factor: 6.558
Authors: Andrew J Schoenfeld; Caleb M Yeung; Daniel G Tobert; Lananh Nguyen; Peter G Passias; John H Shin; James D Kang; Marco L Ferrone Journal: Spine (Phila Pa 1976) Date: 2022-01-15 Impact factor: 3.241