Helping Patients With Spinal Stenosis Make a Treatment Decision: A Randomized Study Assessing The Benefits of Health Coaching

Treatment options for lumbar spinal stenosis include surgical and non-surgical approaches.
For most people, the decision depends on how bothered they are by their symptoms and how
they feel about having surgery. Since individuals with the same clinical presentation may
feel differently about their symptoms and how they view the benefits and harms of their
options, there is no agreed upon "best"treatment. It has been shown that, for
"preference-sensitive" decisions like this one, decision aids (tools that pair balanced,
evidence-based information regarding treatment options with values clarification) improve
patients'knowledge and realistic expectations, lower decisional conflict, increase patient
involvement in decision making, decrease the number of undecided, and increase agreement
between values and choice.1 The Spine Center, in collaboration with the Center for Shared
Decision Making (CSDM) at DHMC, has been providing patients with decision aids (DAs) for
several years.

Hypothesis:

Patients identified as having low literacy and/or high decisional conflict after viewing a
video decision aid will show greater resolution of their decisional conflict, higher
decision self-efficacy and less decision regret if a coaching intervention is paired with a
video decision aid.

Decision support in the form of coaching develops patients'skills in preparing for a
consultation and deliberating about their options.2 A study of women with abnormal uterine
bleeding showed that pairing coaching with a DA helped patients clarify their values and
preferences, reduced costs, and increased long term satisfaction.3 The investigators plan
to assess the impact of coaching in patients with lumbar spinal stenosis who are referred to
the CSDM for a video decision aid about their treatment options. The investigators are
also interested to learn whether screening for low literacy and high decisional conflict can
identify a subgroup of patients who are more likely to benefit from coaching.