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Expectations Affect Treatment Preference for Herniated Discs

Study explores determinants of patient preferences for surgical versus non-operative treatment

FRIDAY, Nov. 21 (HealthDay News) -- In patients with lumbar intervertebral disc herniation, expectations -- particularly concerning the benefit of non-operative treatment -- are the primary determinants of preference for operative or non-operative care, researchers report in the Nov. 15 issue of Spine.

Jon D. Lurie, M.D., of the Dartmouth Medical School in Lebanon, N.H., and colleagues studied 740 patients who failed some non-operative treatment and had been deemed as surgical candidates. The researchers obtained baseline preference and expectation data at enrollment prior to patient exposure to the informed consent process.

The investigators found that 67 percent of the patients preferred surgery, and that 53 percent of the patients who preferred surgery had a definite preference. Patients who preferred surgery tended to be younger, with lower levels of education and higher levels of unemployment, disability, pain and opiate use. The researchers also found that 28 percent of the patients preferred non-operative treatment, and that only 18 percent of them had a definite preference. The strongest predictor of preference in either group was patient expectations concerning improvement with non-operative care.

"There seemed to be a certain reluctance threshold that needed to be overcome for patients to develop a preference for surgery," the authors write. "When the expected benefits were equal, patients tended to prefer non-operative treatment due to perceived higher risk of surgery. When the risks were expected to be equal and the expected benefit from surgery higher -- an expressed risk/benefit ratio in favor of surgery -- patients still remained uncertain in their preference. Only when both the expected benefits from surgery were higher and the expected harms were lower, and in fact when the reported expectation of harm from non-operative care was greater than the expectation of benefit, did patients state a clear preference for surgery."

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