Factors and concerns of patients that influence the decision for spinal surgery and implications for practice: A review of literature

Study design A literature review. Objectives To identify the factors and concerns that influence the decision of patients to undergo spinal surgery. Methods Electronic databases MEDLINE, PsycINFO, CINAHL plus, and Embase were searched for relevant studies published from 2000 to 2015. The keywords for the search included: spine surgery OR spinal stenosis AND decision making OR consideration OR preference OR willingness OR concern. Seven quantitative studies met the criteria for inclusion and were included in this review. Results The findings showed that patients were more likely to decide on surgery when they were suffering from severe bodily pain, poor physical function, poor psychosocial health and a higher level of functional disability. Concerns that affected the patients’ decision on whether or not to opt for surgery were: the benefits weighed against the perceived risks of different modalities of treatment, the effectiveness of medical treatments, their level of satisfaction with their symptoms and a preference for autonomy or a reliance on the opinion of medical professionals. The findings relating to patient characteristics and preference for surgery were inconsistent. Conclusion Patients go through a complex and a multi-factorial process in making the decision whether or not to undergo surgery, which calls for decision support interventions that will help them to make the decision.