1206 Shared Decision-Making in Lumbar Spine Treatment: Feasibility, Patient Reception, and Association With Treatment Concordance

INTRODUCTION: Despite evidence for the effectiveness of shared decision-making (SDM) tools, such as patient decision aids (DAs), these tools are not commonly used in routine spine care despite treatment being preference sensitive. METHODS: In this prospective interventional cohort study, DAs were given to patients diagnosed with lumbar spinal stenosis or disc herniation at Massachusetts General Brigham spine clinics (Apr - Oct 2022). The matched control cohort contained lumbar stenosis and herniated disc patients treated by other spine surgeons within the same clinical practice and timeframe. Multivariable logistic regression assessed associations between cohorts (DA vs. control) and treatment concordance/choice, adjusting for sociodemographic and clinical variables. A retrospective REDCap survey evaluated patients’ perceptions of the DA. RESULTS: 105 patients participated in the DA cohort [age, 62.72 ± 12.68 years] and 154 in the matched control cohort [age, 67.95 ± 12.46 years]. Reviewing the DA took patients 5-10 minutes on average. Use of DAs was not significantly associated with treatment choice for those recommended surgery (p=0.074) nor non-surgical management (p=0.59). The rate of concordance between surgeon recommended and utilized treatments based on available data among those who received DA was 82.8% (82/99) vs. 71.4% (110/154) (p=0.055). Most patients, 88% (92/105), found the DA at least “Somewhat helpful” and 97.9% (102/105) believed it was at least “Somewhat important” for physicians to provide DAs to patients. CONCLUSIONS: A positive association existed between DA receipt and treatment choice concordance with surgeon recommendation. Findings suggest that DAs are generally well-accepted, useful tools to facilitate informed decision-making, leading to increased comfort and alignment with patients’ chosen management approach for lumbar spinal stenosis or disc herniation.