title: Helping patients decide about back surgery: a randomized trial of an interactive video program.
abstract: METHODS
  A randomized trial of 100 patients with low back pain who were potential surgical candidates.
  
  
  OBJECTIVE
  To determine whether an interactive videodisc with a booklet is superior to a booklet alone for informing patients about back surgery.
  
  
  BACKGROUND
  Substantial geographic variation has been observed in lumbar spine surgery. Informed patient preferences should play an important role in decisions about surgery. However, little is known about optimal strategies for informing patients.
  
  
  METHODS
  Subjects were randomized to receive an interactive videodisc (with a booklet) or a booklet alone. A knowledge test administered at baseline and follow-up was used to measure improvement in knowledge about treatment options for lumbar spine problems. Patients' reactions to the videodisc and booklet and preferences for treatment were also assessed.
  
  
  RESULTS
  The patients' knowledge improved after exposure to either intervention. Multivariate analyses adjusted for baseline score, age, education, gender, and diagnosis showed a significant advantage for the videodisc with booklet over the booklet alone. The videodisc-booklet group showed significantly greater gains in knowledge among subjects with the worst baseline knowledge scores. A larger proportion of subjects in the videodisc-booklet group rated the materials easy to understand (93% vs.- 72%,P = 0.04), containing the right amount of information (93% vs.- 80%,P = 0.3), and adequate to assist in choice of treatment (75% vs.- 51%,P = 0.2). Those who viewed the videodisc expressed a somewhat lower preference for surgery than those who received the booklet alone (23% vs.- 42%,P = 0.4).
  
  
  CONCLUSIONS
  Both the booklet alone and the combination of videodisc and booklet improved knowledge. The combination produced greater knowledge gains than the booklet alone for the subgroup with the least knowledge at baseline. Patients preferred the combination and had a slightly lower preference for surgery if they had viewed the video presentation. For some patients, the video may enhance involvement in clinical decisions.
authors.affiliation: Department of Medicine, University of Washington, Seattle, Washington, USA. phelane@u.washington.edu
authors.forename: E A
authors.initials: EA
authors.lastname: Phelan
authors.forename: R A
authors.initials: RA
authors.lastname: Deyo
authors.forename: D C
authors.initials: DC
authors.lastname: Cherkin
authors.forename: J N
authors.initials: JN
authors.lastname: Weinstein
authors.forename: M A
authors.initials: MA
authors.lastname: Ciol
authors.forename: W
authors.initials: W
authors.lastname: Kreuter
authors.forename: J F
authors.initials: JF
authors.lastname: Howe
mesh_terms: D000328:Adult; D000368:Aged; D001416:Back Pain / Q000523:psychology* / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D019637:Orthopedic Procedures / Q000523:psychology*; D010174:Pamphlets; D010353:Patient Education as Topic; D010817:Physician-Patient Relations; D014742:Videodisc Recording