Distributed decision-making for lumbar spine surgery: A qualitative interview study with patients and neurosurgeons

Lower back pain with or without radiating leg pain is a leading cause of disability worldwide. Several treatment options are available, and this article aims to understand better the decision-making involved in selecting appropriate treatments. A qualitative interview study was conducted with patients with lumbar spinal disorders and neurosurgeons specialising in spine surgery. Both groups of participants were asked to reflect on the decision-making process regarding whether to pursue surgery for back pain. The theoretical approach of distributed decision-making was applied. Results indicated that patients activated diverse information sources and considerations derived from their social networks when in the consultation room. Surgeons, on the other hand, were equipped with research-based knowledge and clinical practice experience. Effective communication was a shared concern for patients and surgeons during the actual decision-making. Factors such as patient diversity, the language used to discuss disease and illness, and the interpretation of risks played pivotal roles in the decision-making process. Regarding self-understanding, patients acted as agents for illness coping in their social networks. Surgeons recognised the imperative skill of facilitating rich patient dialogue as a crucial element in shared decision-making regarding potential surgical interventions. These findings demonstrate the importance of understanding decision-making as a distributed process where patients and clinicians are embedded in social networks and institutional contexts. In this process, patients must be recognised and engaged as individuals with diverse backgrounds and needs, especially during discussions focused on determining the most effective treatment approach for their specific cases.