Patient Experiences of Making Treatment Decisions for Lumbar Disc Herniation: A Qualitative Study

Study Design: Qualitative interview study. Objective: To describe, from the patient's perspective, how individuals with lumbar disc herniation (LDH) experience and navigate treatment decision-making for their condition. Summary of Background Data: Pain and disability caused by LDH can be managed both surgically and nonsurgically. For many patients, there are no definitive clinical indications for a single treatment approach, making decision-making nuanced and largely driven by the patient’s symptoms and lived experience. Given evidence pointing to the patient’s role in decision-making for LDH and related treatment satisfaction, qualitative research to better understand how patients with LDH make decisions can guide patients and clinicians in making higher-quality decisions together. Materials and Methods: This study was conducted at an urban academic health system. The sample included 31 adults (ages 20–80 yr; 20 women, 11 men) with imaging-confirmed LDH who had not undergone prior spine surgery. Participants completed one semistructured interview within 2 to 4 weeks after consultation with a spine surgeon. Interview transcripts were thematically analyzed, and patient perspectives of decision-making were synthesized into themes and subthemes. Results: Three themes characterized patient experiences of treatment decision-making. “Perceiving treatment decisions as fast- or slow-paced” reflected how the perceived pace of decisions could influence decision quality over time. “Evaluating treatment options through a highly personalized lens” described how participants interpreted options according to their symptoms, goals, experiences, and circumstances. “Seeking and making sense of information to navigate uncertainty” captured how participants used information from multiple sources to understand their condition and treatment options. Conclusions: Treatment decision-making in LDH is an individualized, dynamic experience. Shared decision-making in LDH requires ongoing communication that acknowledges uncertainty and accounts for how patients construct contextualized appropriateness of treatment options.