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Clinician Experiences in Treatment Decision-Making for Patients with Spinal Metastases: A Qualitative Study.

Publication ,  Journal Article
Barton, LB; Arant, KR; Blucher, JA; Sarno, DL; Redmond, KJ; Balboni, TA; Colman, M; Goodwin, CR; Laufer, I; Placide, R; Shin, JH; Sciubba, DM ...
Published in: The Journal of bone and joint surgery. American volume
January 2021

Effective management of metastatic disease requires multidisciplinary input and entails high risk of disease-related and treatment-related morbidity and mortality. The factors that influence clinician decision-making around spinal metastases are not well understood. We conducted a qualitative study that included a multidisciplinary cohort of physicians to evaluate the decision-making process for treatment of spinal metastases from the clinician's perspective.We recruited operative and nonoperative clinicians, including orthopaedic spine surgeons, neurosurgeons, radiation oncologists, and physiatrists, from across North America to participate in either a focus group or a semistructured interview. All interviews were audiorecorded and transcribed verbatim. We then performed a thematic analysis using all of the available transcript data. Investigators sequentially coded transcripts and identified recurring themes that encompass overarching patterns in the data and directly bear on the guiding study question. This was followed by the development of a thematic map that visually portrays the themes, the subthemes, and their interrelatedness, as well as their influence on treatment decision-making.The thematic analysis revealed that numerous factors influence provider-based decision-making for patients with spinal metastases, including clinical elements of the disease process, treatment guidelines, patient preferences, and the dynamics of the multidisciplinary care team. The most prominent feature that resonated across all of the interviews was the importance of multidisciplinary care and the necessity of cohesion among a team of diverse health-care providers. Respondents emphasized aspects of care-team dynamics, including effective communication and intimate knowledge of team-member preferences, as necessary for the development of appropriate treatment strategies. Participants maintained that the primary role in decision-making should remain with the patient.Numerous factors influence provider-based decision-making for patients with spinal metastases, including multidisciplinary team dynamics, business pressure, and clinician experience. Participants maintained a focus on shared decision-making with patients, which contrasts with patient preferences to defer decisions to the physician, as described in prior work.The results of this thematic analysis document the numerous factors that influence provider-based decision-making for patients with spinal metastases. Our results indicate that provider decisions regarding treatment are influenced by a combination of clinical characteristics, perceptions of patient quality of life, and the patient's preferences for care.

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Published In

The Journal of bone and joint surgery. American volume

DOI

EISSN

1535-1386

ISSN

0021-9355

Publication Date

January 2021

Volume

103

Issue

1

Start / End Page

e1

Related Subject Headings

  • Spinal Neoplasms
  • Specialties, Surgical
  • Quality of Life
  • Qualitative Research
  • Patient Preference
  • Patient Care Team
  • Orthopedics
  • Middle Aged
  • Medicine
  • Male
 

Citation

APA
Chicago
ICMJE
MLA
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Barton, L. B., Arant, K. R., Blucher, J. A., Sarno, D. L., Redmond, K. J., Balboni, T. A., … Schoenfeld, A. J. (2021). Clinician Experiences in Treatment Decision-Making for Patients with Spinal Metastases: A Qualitative Study. The Journal of Bone and Joint Surgery. American Volume, 103(1), e1. https://doi.org/10.2106/jbjs.20.00334
Barton, Lauren B., Kaetlyn R. Arant, Justin A. Blucher, Danielle L. Sarno, Kristin J. Redmond, Tracy A. Balboni, Matthew Colman, et al. “Clinician Experiences in Treatment Decision-Making for Patients with Spinal Metastases: A Qualitative Study.The Journal of Bone and Joint Surgery. American Volume 103, no. 1 (January 2021): e1. https://doi.org/10.2106/jbjs.20.00334.
Barton LB, Arant KR, Blucher JA, Sarno DL, Redmond KJ, Balboni TA, et al. Clinician Experiences in Treatment Decision-Making for Patients with Spinal Metastases: A Qualitative Study. The Journal of bone and joint surgery American volume. 2021 Jan;103(1):e1.
Barton, Lauren B., et al. “Clinician Experiences in Treatment Decision-Making for Patients with Spinal Metastases: A Qualitative Study.The Journal of Bone and Joint Surgery. American Volume, vol. 103, no. 1, Jan. 2021, p. e1. Epmc, doi:10.2106/jbjs.20.00334.
Barton LB, Arant KR, Blucher JA, Sarno DL, Redmond KJ, Balboni TA, Colman M, Goodwin CR, Laufer I, Placide R, Shin JH, Sciubba DM, Losina E, Katz JN, Schoenfeld AJ. Clinician Experiences in Treatment Decision-Making for Patients with Spinal Metastases: A Qualitative Study. The Journal of bone and joint surgery American volume. 2021 Jan;103(1):e1.

Published In

The Journal of bone and joint surgery. American volume

DOI

EISSN

1535-1386

ISSN

0021-9355

Publication Date

January 2021

Volume

103

Issue

1

Start / End Page

e1

Related Subject Headings

  • Spinal Neoplasms
  • Specialties, Surgical
  • Quality of Life
  • Qualitative Research
  • Patient Preference
  • Patient Care Team
  • Orthopedics
  • Middle Aged
  • Medicine
  • Male