title: Effects of viewing an evidence-based video decision aid on patients' treatment preferences for spine surgery.
abstract: METHODS
  Secondary analysis within a large clinical trial.
  
  
  OBJECTIVE
  To evaluate the changes in treatment preference before and after watching a video decision aid as part of an informed consent process.
  
  
  BACKGROUND
  A randomized trial with a similar decision aid in herniated disc patients had shown decreased rate of surgery in the video group, but the effect of the video on expressed preferences is not known.
  
  
  METHODS
  Subjects enrolling in the Spine Patient Outcomes Research Trial (SPORT) with intervertebral disc herniation, spinal stenosis, or degenerative spondylolisthesis at 13 multidisciplinary spine centers across the United States were given an evidence-based videotape decision aid viewed prior to enrollment as part of informed consent.
  
  
  RESULTS
  Of the 2505 patients, 86% (n = 2151) watched the video and 14% (n = 354) did not. Watchers shifted their preference more often than nonwatchers (37.9% vs. 20.8%, P < 0.0001) and more often demonstrated a strengthened preference (26.2% vs. 11.1%, P < 0.0001). Among the 806 patients whose preference shifted after watching the video, 55% shifted toward surgery (P = 0.003). Among the 617 who started with no preference, after the video 27% preferred nonoperative care, 22% preferred surgery, and 51% remained uncertain.
  
  
  CONCLUSIONS
  After watching the evidence-based patient decision aid (video) used in SPORT, patients with specific lumbar spine disorders formed and/or strengthened their treatment preferences in a balanced way that did not appear biased toward or away from surgery.
authors.affiliation: Dartmouth Medical School, Hanover, NH, USA. jon.d.lurie@hitc hcock.org
authors.forename: Jon D
authors.initials: JD
authors.lastname: Lurie
authors.forename: Kevin F
authors.initials: KF
authors.lastname: Spratt
authors.forename: Emily A
authors.initials: EA
authors.lastname: Blood
authors.forename: Tor D
authors.initials: TD
authors.lastname: Tosteson
authors.forename: Anna N A
authors.initials: AN
authors.lastname: Tosteson
authors.forename: James N
authors.initials: JN
authors.lastname: Weinstein
mesh_terms: D000328:Adult; D003661:Decision Support Techniques; D019317:Evidence-Based Medicine / Q000379:methods*; D005260:Female; D006801:Humans; D007405:Intervertebral Disc Displacement / Q000601:surgery; D008297:Male; D008875:Middle Aged; D019637:Orthopedic Procedures / Q000379:methods / Q000523:psychology*; D057240:Patient Preference / Q000523:psychology* / Q000706:statistics & numerical data; D013130:Spinal Stenosis / Q000601:surgery; D013168:Spondylolisthesis / Q000601:surgery; D014743:Videotape Recording